1922351063 NPI number — ARLENE VIRAY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922351063 NPI number — ARLENE VIRAY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARLENE VIRAY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ARLENE VIRAY, MD
Provider Other Organization Name Type Code:
3
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:
1922351063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 W 2ND ST
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82601-2454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-235-2552
Provider Business Mailing Address Fax Number:
307-237-5568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 W 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601-2454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-235-2552
Provider Business Practice Location Address Fax Number:
307-237-5568
Provider Enumeration Date:
10/25/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHANKLIN
Authorized Official First Name:
ARLENE
Authorized Official Middle Name:
V
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
307-235-2552

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  1128 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC 276 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC357 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 5753A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 111020900 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".