1639212657 NPI number — KATIE E DAWSON MD

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 1639212657 NPI number — KATIE E DAWSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAWSON
Provider First Name:
KATIE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1639212657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 W PENNSYLVANIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANACONDA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59711-1999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-563-8500
Provider Business Mailing Address Fax Number:
406-563-8694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 S ALABAMA ST STE 6A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTTE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59701-2358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-782-2329
Provider Business Practice Location Address Fax Number:
406-782-2890
Provider Enumeration Date:
02/15/2007

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: 208600000X , with the licence number:  7301 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51462 . This is a "STATE LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 1639212657 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com