1033175831 NPI number — MELINDA J. POYER D.O.

Table of content: PETRE FILIP (NPI 1053024653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033175831 NPI number — MELINDA J. POYER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POYER
Provider First Name:
MELINDA
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1033175831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1180 COLLEGE DR
Provider Second Line Business Mailing Address:
SUITE 3-2
Provider Business Mailing Address City Name:
ROCK SPRINGS
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82901-5863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-362-0083
Provider Business Mailing Address Fax Number:
307-362-0084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 COLLEGE DR
Provider Second Line Business Practice Location Address:
SUITE 3-2
Provider Business Practice Location Address City Name:
ROCK SPRINGS
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82901-5863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-362-0083
Provider Business Practice Location Address Fax Number:
307-362-0084
Provider Enumeration Date:
04/21/2006

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: 207Q00000X , with the licence number:  7530A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 254389300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8356392006 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 239383 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 57569 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00014587 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 26544 . This is a "STAYWELL/WELLCARE/HEALTHE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7985065 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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