1669526927 NPI number — HEMATOLOGY ONCOLOGY CENTERS OF THE NORTHERN ROCKIES PC

Table of content: (NPI 1669526927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669526927 NPI number — HEMATOLOGY ONCOLOGY CENTERS OF THE NORTHERN ROCKIES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEMATOLOGY ONCOLOGY CENTERS OF THE NORTHERN ROCKIES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1669526927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30976
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILLINGS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59107-0976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-238-6290
Provider Business Mailing Address Fax Number:
406-238-6961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 AVENUE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POWELL
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82435-2260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-238-6290
Provider Business Practice Location Address Fax Number:
406-238-6961
Provider Enumeration Date:
01/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BEALER
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
406-238-6285

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1145420005 . This is a "DMERC ID POWELL WY SITE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".