1578507380 NPI number — DR. JONIE MYRSTOL GIROUARD M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578507380 NPI number — DR. JONIE MYRSTOL GIROUARD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIROUARD
Provider First Name:
JONIE
Provider Middle Name:
MYRSTOL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HINES
Provider Other First Name:
JONIE
Provider Other Middle Name:
MYRSTOL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578507380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15806 BROOKWAY DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
HUNTERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28078-3237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-766-1000
Provider Business Mailing Address Fax Number:
704-766-1002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15806 BROOKWAY DR
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-766-1000
Provider Business Practice Location Address Fax Number:
704-766-1002
Provider Enumeration Date:
06/15/2006

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: 207Q00000X , with the licence number:  33632 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2210052 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 314566 . This is a "BCBS PIN" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 0157386 . This is a "MDCD PIN" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 123496000 . This is a "MDCD PIN" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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