1184859159 NPI number — SHERI ANN SHELTON PT

Table of content: SHERI ANN SHELTON PT (NPI 1184859159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184859159 NPI number — SHERI ANN SHELTON PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELTON
Provider First Name:
SHERI
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOROSCHUK
Provider Other First Name:
SHERI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184859159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 SW INDUSTRIAL WAY
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97702-1093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-585-2529
Provider Business Mailing Address Fax Number:
541-585-2535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 SW CENTURY DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97702-1657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-322-9045
Provider Business Practice Location Address Fax Number:
541-322-9044
Provider Enumeration Date:
05/20/2009

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: 225100000X , with the licence number:  5907 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 059333037 . This is a "REGENCE BLUE CROSS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com