1912238122 NPI number — MRS. CLYTIE JUNE RING CDCIII,CADCII,NACAI

Table of content: MRS. CLYTIE JUNE RING CDCIII,CADCII,NACAI (NPI 1912238122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912238122 NPI number — MRS. CLYTIE JUNE RING CDCIII,CADCII,NACAI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RING
Provider First Name:
CLYTIE
Provider Middle Name:
JUNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CDCIII,CADCII,NACAI
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:
1912238122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 - 5TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KLAMATH FALLS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-337-1830
Provider Business Mailing Address Fax Number:
541-273-0157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 S 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97601-6107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-273-5297
Provider Business Practice Location Address Fax Number:
541-273-0157
Provider Enumeration Date:
01/28/2010

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: 101YA0400X , with the licence number:  10-4514 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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