1073605812 NPI number — MS. SHEINA S IVEY HIS

Table of content: MS. SHEINA S IVEY HIS (NPI 1073605812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073605812 NPI number — MS. SHEINA S IVEY HIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IVEY
Provider First Name:
SHEINA
Provider Middle Name:
S
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
HIS
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:
1073605812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8800 SE SUNNYSIDE RD STE 300N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLACKAMAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97015-5703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-286-2999
Provider Business Mailing Address Fax Number:
512-607-4893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1624 WEST MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMI
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62821-2235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-382-3123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2006

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: 237600000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 2637 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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