1104135375 NPI number — NINON GERMAIN MD PLLC

Table of content: (NPI 1487163069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104135375 NPI number — NINON GERMAIN MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NINON GERMAIN MD PLLC
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:
1104135375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
413 N ALLUMBAUGH ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83704-9219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-323-1125
Provider Business Mailing Address Fax Number:
208-323-9604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
413 N ALLUMBAUGH ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83704-9219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-323-1125
Provider Business Practice Location Address Fax Number:
208-323-9604
Provider Enumeration Date:
10/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DUNBAR
Authorized Official First Name:
ALISON
Authorized Official Middle Name:
Authorized Official Title or Position:
REIMBURSEMENT MANAGER
Authorized Official Telephone Number:
208-323-1125

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X , with the licence number:  M8955 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1550780 . This is a "PTAN" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com