1104498732 NPI number — SAMUNDRA BHATTARAI

Table of content: SAMUNDRA BHATTARAI (NPI 1104498732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104498732 NPI number — SAMUNDRA BHATTARAI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHATTARAI
Provider First Name:
SAMUNDRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1104498732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2384
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAYENTA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86033-2384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
280-602-9226
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
394.3 US-160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAYENTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-697-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2021

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: 183500000X , with the licence number:  033.0134475 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: PHCY-01155 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHCY-01155 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 033.0134475 . This is a "LICENSE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".