1013179597 NPI number — PACIFIC COAST SPINE CENTER A PHYSICAL THERAPY CORP

Table of content: DR. SILKE NATASHA HUNTER M.D. (NPI 1275854028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013179597 NPI number — PACIFIC COAST SPINE CENTER A PHYSICAL THERAPY CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC COAST SPINE CENTER A PHYSICAL THERAPY CORP
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:
Provider Other Organization Name Type Code:
6
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:
1013179597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
880 OAK PARK BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
ARROYO GRANDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93420-1821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-489-1477
Provider Business Mailing Address Fax Number:
805-489-2356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 OAK PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
ARROYO GRANDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93420-1821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-489-1477
Provider Business Practice Location Address Fax Number:
805-489-2356
Provider Enumeration Date:
06/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-489-1477

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  C3123027 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 55851 . This is a "CITY BUSINESS LICENSE-ARROYO GRANDE, CA 93420" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: C3123027 . This is a "CORPORATION NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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