1396810792 NPI number — DR. SHEILA KUTZ AUD., CCC-A

Table of content: DR. SHEILA KUTZ AUD., CCC-A (NPI 1396810792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396810792 NPI number — DR. SHEILA KUTZ AUD., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUTZ
Provider First Name:
SHEILA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD., CCC-A
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:
1396810792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 SOUTH 3RD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62246-1733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-664-1146
Provider Business Mailing Address Fax Number:
618-664-4576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 S 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62246-1733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-664-1146
Provider Business Practice Location Address Fax Number:
618-664-4576
Provider Enumeration Date:
11/21/2006

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: 231H00000X , with the licence number:  147-00177 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000332001 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4500135 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 478224 . This is a "HEALTHLINK INSURANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".