1457510851 NPI number — TORI ANN BICKERTON NAVY IDC

Table of content: TORI ANN BICKERTON NAVY IDC (NPI 1457510851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457510851 NPI number — TORI ANN BICKERTON NAVY IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BICKERTON
Provider First Name:
TORI
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NAVY IDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HIGGINS
Provider Other First Name:
TORI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NAVY IDC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457510851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BRANCH HEALTH CLINIC NAVAL AIR FACILITY
Provider Second Line Business Mailing Address:
BLDG 523
Provider Business Mailing Address City Name:
EL CENTRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92243-5015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-339-2674
Provider Business Mailing Address Fax Number:
760-339-2661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BRANCH HEALTH CLINIC NAVAL AIR FACILITY
Provider Second Line Business Practice Location Address:
BLDG 523
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-5015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-339-2674
Provider Business Practice Location Address Fax Number:
760-339-2661
Provider Enumeration Date:
06/02/2008

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: 1710I1002X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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