1821211616 NPI number — MR. KJELL B RISUNG P.T

Table of content: MR. KJELL B RISUNG P.T (NPI 1821211616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821211616 NPI number — MR. KJELL B RISUNG P.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RISUNG
Provider First Name:
KJELL
Provider Middle Name:
B
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T
Provider Gender Code:
M

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:
1821211616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FRONTIER THERAPY SERVICES
Provider Second Line Business Mailing Address:
108 EAST CORRAL
Provider Business Mailing Address City Name:
SOLDOTNA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-260-5893
Provider Business Mailing Address Fax Number:
907-260-5814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FRONTIER THERAPY SERVICES
Provider Second Line Business Practice Location Address:
108 EAST CORRAL
Provider Business Practice Location Address City Name:
SOLDOTNA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-260-5893
Provider Business Practice Location Address Fax Number:
907-260-5814
Provider Enumeration Date:
04/10/2007

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: 2251X0800X , with the licence number:  535 , 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: TC851 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".