1780692046 NPI number — KRISTIN M WEBB PA

Table of content: KRISTIN M WEBB PA (NPI 1780692046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780692046 NPI number — KRISTIN M WEBB PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBB
Provider First Name:
KRISTIN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1780692046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6255 SHERIDAN DR
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-4836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-857-8666
Provider Business Mailing Address Fax Number:
716-857-8994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 LIMESTONE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221-7051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-631-2517
Provider Business Practice Location Address Fax Number:
716-634-5650
Provider Enumeration Date:
08/03/2006

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: 363A00000X , with the licence number:  007459-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00026555301 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02210704 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9512301 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00090590 . This is a "RR MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000570246006 . This is a "HEALTH NOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com