1457321010 NPI number — LAURA A BONSNESS PT

Table of content: LAURA A BONSNESS PT (NPI 1457321010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457321010 NPI number — LAURA A BONSNESS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONSNESS
Provider First Name:
LAURA
Provider Middle Name:
A
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:
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:
1457321010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6850
Provider Second Line Business Mailing Address:
7220 S HIGHWAY 16
Provider Business Mailing Address City Name:
RAPID CITY
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57709-6850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-341-1414
Provider Business Mailing Address Fax Number:
605-341-7062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7220 S HIGHWAY 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57702-8708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-341-1414
Provider Business Practice Location Address Fax Number:
605-341-7062
Provider Enumeration Date:
01/25/2006

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: 225100000X , with the licence number:  1152 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5833280 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1254560001 . This is a "CIGNA MEDICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 650023226 . This is a "MEDICARE RAILROAD PTAN" identifier . This identifiers is of the category "OTHER".