1942313424 NPI number — MR. NICHOLAS ELIAS NIGHT I LMT/ CST/ AMMP

Table of content: MR. NICHOLAS ELIAS NIGHT I LMT/ CST/ AMMP (NPI 1942313424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942313424 NPI number — MR. NICHOLAS ELIAS NIGHT I LMT/ CST/ AMMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIGHT
Provider First Name:
NICHOLAS
Provider Middle Name:
ELIAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
I
Provider Credential Text:
LMT/ CST/ AMMP
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:
1942313424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 SHATTUCK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISBEE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85603-1548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-255-1519
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 SUBWAY ST.
Provider Second Line Business Practice Location Address:
SUITES D & E
Provider Business Practice Location Address City Name:
BISBEE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-255-1519
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2006

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: 225200000X , with the licence number:  06002128A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: MA 37184 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: MA 00007960 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: MT08447 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 601-628-074 . This is a "UNIFIED BUSINESS IDENTIFI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 81768 . This is a "LABOR & INDUSTRIES #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 91-1680461 . This is a "EMPLOYER IDENTIFICATION #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1942313424 . This is a "NPPES NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 121-001-000 . This is a "US DEPT. OF LABOR PROV. #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 21257-00 . This is a "NCBTMB LIC. #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 451430-10 . This is a "NCBTMB CEU PROVIDER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: C-2035 . This is a "BLUE CROSS BLUE SHIELD PI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: MY8742 . This is a "REGENCE INSURANCE ID #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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