1104436104 NPI number — DR. MARTHA LOUISE MCKINNEY MD MPH

Table of content: DR. MARTHA LOUISE MCKINNEY MD MPH (NPI 1104436104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104436104 NPI number — DR. MARTHA LOUISE MCKINNEY MD MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKINNEY
Provider First Name:
MARTHA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD MPH
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:
1104436104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 HOSPITAL DR
Provider Second Line Business Mailing Address:
PEDIATRIC RESPIROLOGY
Provider Business Mailing Address City Name:
SASKATOON
Provider Business Mailing Address State Name:
SK
Provider Business Mailing Address Postal Code:
S7N 0W8
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 HOSPITAL DR
Provider Second Line Business Practice Location Address:
PEDIATRIC RESPIROLOGY
Provider Business Practice Location Address City Name:
SASKATOON
Provider Business Practice Location Address State Name:
SK
Provider Business Practice Location Address Postal Code:
S7N 0W8
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
306-844-1275
Provider Business Practice Location Address Fax Number:
306-844-1514
Provider Enumeration Date:
08/04/2020

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: 2080P0214X , with the licence number:  G85271 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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