1316136351 NPI number — MS. AMANDA BETH BYERS P.A.-C

Table of content: MS. AMANDA BETH BYERS P.A.-C (NPI 1316136351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316136351 NPI number — MS. AMANDA BETH BYERS P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYERS
Provider First Name:
AMANDA
Provider Middle Name:
BETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
Provider Gender Code:
F

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:
1316136351
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MERCADO ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81301-7308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-375-3643
Provider Business Mailing Address Fax Number:
970-375-0007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MERCADO ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-375-3643
Provider Business Practice Location Address Fax Number:
970-375-0007
Provider Enumeration Date:
10/16/2007

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: 207XS0114X , with the licence number:  PA05445 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA05445 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8Y3146 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 142946601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".