1063547164 NPI number — KIRT BIERIG D O INC

Table of content: (NPI 1063547164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063547164 NPI number — KIRT BIERIG D O INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIRT BIERIG D O INC
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:
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:
1063547164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 952
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALVA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73717-0952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-327-7842
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 4TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ALVA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73717-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-327-7842
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BIERIG
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
580-327-7842

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2013 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 246721201 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100736170 A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: DN3274 . This is a "RAILROAD MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100094160 A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600522385 . This is a "MEDICARE PTAN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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