1275612616 NPI number — MARK SHEIKO MD

Table of content: MARK SHEIKO MD (NPI 1275612616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275612616 NPI number — MARK SHEIKO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEIKO
Provider First Name:
MARK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1275612616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILLINGS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59107-5100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-238-2500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 10TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59101-0703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-238-2500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2006

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: 207ZC0500X , with the licence number:  4653 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 4653 , 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: 000016001 . This is a "BCBS PIN" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0012257 . This is a "MDCD PIN" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 101795100 . This is a "MDCD PIN" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".