1073500336 NPI number — DR. ANTONIO HODGES SANTIN MDFAC

Table of content: DR. ANTONIO HODGES SANTIN MDFAC (NPI 1073500336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073500336 NPI number — DR. ANTONIO HODGES SANTIN MDFAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTIN
Provider First Name:
ANTONIO
Provider Middle Name:
HODGES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MDFAC
Provider Gender Code:
M

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:
1073500336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59406-6010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-731-8888
Provider Business Mailing Address Fax Number:
406-731-8318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1645 VANDELAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601-3929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-731-8888
Provider Business Practice Location Address Fax Number:
406-731-8318
Provider Enumeration Date:
10/03/2005

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: 174400000X , with the licence number:  7778 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 7778 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0013936 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 240004926 . This is a "RAILROAD MEDICARE NUMBER" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 009651 . This is a "BLUE CROSS OF MONTANA" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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