1124356134 NPI number — MRS. KATHRYN MARY FOX QMHA

Table of content: MRS. KATHRYN MARY FOX QMHA (NPI 1124356134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124356134 NPI number — MRS. KATHRYN MARY FOX QMHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOX
Provider First Name:
KATHRYN
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
QMHA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUGHES
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
QMHA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124356134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4570 ANTONIA AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97301-2183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-584-1624
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2421 LANCASTER DR NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97305-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-576-4571
Provider Business Practice Location Address Fax Number:
503-576-4577
Provider Enumeration Date:
12/02/2009

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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