1033142443 NPI number — INCORPORATED COUNTY OF LOS ALAMOS

Table of content: JANE KIM BOUCHER PHARM.D. (NPI 1275617631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033142443 NPI number — INCORPORATED COUNTY OF LOS ALAMOS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INCORPORATED COUNTY OF LOS ALAMOS
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:
1033142443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
999 CENTRAL AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ALAMOS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87544-3328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-662-8318
Provider Business Mailing Address Fax Number:
505-662-8302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LOS ALAMOS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87544-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-662-8318
Provider Business Practice Location Address Fax Number:
505-662-8302
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARTLETT
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS DIVISION CHIEF
Authorized Official Telephone Number:
505-709-5042

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  41036 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201080137 . This is a "PRESBYTERIAN SALUD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 4074870 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: G008A95 . This is a "MUTUAL OF OMAHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00NM00R031 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000R2247 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3142 . This is a "KAISER PERMANENTE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201080137 . This is a "PRESBYTERIAN INSURANCE C" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13847 . This is a "PRESBYTERIAN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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