1780881391 NPI number — MRS. KYLEE BETH GEER

Table of content: MRS. KYLEE BETH GEER (NPI 1780881391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780881391 NPI number — MRS. KYLEE BETH GEER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEER
Provider First Name:
KYLEE
Provider Middle Name:
BETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1780881391
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 MAIN STREET S.
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
MINOT
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58701-3731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-837-9801
Provider Business Mailing Address Fax Number:
866-666-9789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 MAIN STREET S.
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MINOT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58701-3731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-837-9801
Provider Business Practice Location Address Fax Number:
866-666-9789
Provider Enumeration Date:
06/27/2007

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: 235Z00000X , with the licence number:  987 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 8191 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 28240 . This is a "BCBS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 51627 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".