1942369186 NPI number — ALPHA L MAHLER NP

Table of content: ALPHA L MAHLER NP (NPI 1942369186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942369186 NPI number — ALPHA L MAHLER NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHLER
Provider First Name:
ALPHA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1942369186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
366 N MERIDIAN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUPERT
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83350-8535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-436-6266
Provider Business Mailing Address Fax Number:
208-678-0909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1945 HILAND AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BURLEY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83318-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-678-0900
Provider Business Practice Location Address Fax Number:
208-678-0909
Provider Enumeration Date:
12/06/2006

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: 363L00000X , with the licence number:  NP-267A , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NPHV1 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010171038 . This is a "REGENCE BLUE SHIELD OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 805371400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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