1013902758 NPI number — CHRISTINE M BABCOCK A.N.P.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013902758 NPI number — CHRISTINE M BABCOCK A.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BABCOCK
Provider First Name:
CHRISTINE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013902758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
506 LAKE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENAI
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99611-6937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-714-4025
Provider Business Mailing Address Fax Number:
907-335-0064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 LAKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENAI
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99611-6937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-714-4025
Provider Business Practice Location Address Fax Number:
907-335-0064
Provider Enumeration Date:
09/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  175 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 162271 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 175 . This is a "ALASKA LICENSE #" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 920077523 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: NP39991 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1255528733 . This is a "NPI GROUP NUMBER" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: MDG830 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152261 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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