1619967023 NPI number — MS. MERILYN TSO PA-C

Table of content: MS. MERILYN TSO PA-C (NPI 1619967023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619967023 NPI number — MS. MERILYN TSO PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TSO
Provider First Name:
MERILYN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1619967023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHIPROCK
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87420-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-368-6401
Provider Business Mailing Address Fax Number:
505-368-6431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
US HWY 491 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHIPROCK
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-368-6401
Provider Business Practice Location Address Fax Number:
505-368-6431
Provider Enumeration Date:
10/26/2005

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: 363A00000X , with the licence number:  PA20020017 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: R5007 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12927759 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 434887 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com