1043280050 NPI number — DR. SUSAN ADAMS MARIK M.D.

Table of content: MRS. NANCY BEWLEY M.A.T CCC-SLP (NPI 1669664991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043280050 NPI number — DR. SUSAN ADAMS MARIK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARIK
Provider First Name:
SUSAN
Provider Middle Name:
ADAMS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1043280050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 W PORPHYRY ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTTE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59701-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-496-3627
Provider Business Mailing Address Fax Number:
406-723-2496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 W PORPHYRY ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTTE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59701-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-496-3627
Provider Business Practice Location Address Fax Number:
406-723-2496
Provider Enumeration Date:
01/23/2006

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: 207V00000X , with the licence number:  21575 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 83792 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4512373 . This is a "AETNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 195790 . This is a "MEDCOST" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: P00041395 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: T57872 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8906392 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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