1508987710 NPI number — DAVID G. KITTS, M.D., INC

Table of content: (NPI 1508987710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508987710 NPI number — DAVID G. KITTS, M.D., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID G. KITTS, M.D., INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1508987710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89533-4120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-747-5050
Provider Business Mailing Address Fax Number:
775-747-5005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10956 DONNER PASS RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
TRUCKEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96161-4861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-550-8189
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KITTS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
530-550-8189

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  G59846 , 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)

  • Identifier: 00G598460 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com