1265616783 NPI number — KAREN PUDGE DBA FORGET-ME-NOT CARE COORDINATION

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 1265616783 NPI number — KAREN PUDGE DBA FORGET-ME-NOT CARE COORDINATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAREN PUDGE DBA FORGET-ME-NOT CARE COORDINATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KAREN PUDGE DBA FORGET -ME-NOT CARE COORDINATION
Provider Other Organization Name Type Code:
3
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:
1265616783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 110297
Provider Second Line Business Mailing Address:
FOREGET-ME-NOT CARE COORDINATION
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99511-0297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-646-9877
Provider Business Mailing Address Fax Number:
907-646-1991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4350 E 145TH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-646-9877
Provider Business Practice Location Address Fax Number:
907-646-1991
Provider Enumeration Date:
12/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PUDGE
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
SOLE EMPLOYEE PROPRIETOR
Authorized Official Telephone Number:
907-646-9877

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  746363 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: 746363 , 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: CM861611588848097 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: CMG8611265616783 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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