1134232069 NPI number — SUSAN M ROOKS CNM, MPH

Table of content: SUSAN M ROOKS CNM, MPH (NPI 1134232069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134232069 NPI number — SUSAN M ROOKS CNM, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROOKS
Provider First Name:
SUSAN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM, 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:
1134232069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 HIGHWAY 71 S STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57747-8801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-745-5188
Provider Business Mailing Address Fax Number:
605-745-3039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 HIGHWAY 71 S STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57747-8801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-745-5188
Provider Business Practice Location Address Fax Number:
605-745-3039
Provider Enumeration Date:
08/16/2006

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: 367A00000X , with the licence number:  R025362 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4995586 . This is a "BC/BS PROVIDER #" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6540132 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4683 . This is a "DAKOTACARE PROVIDER #" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5307030 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9191420 . This is a "DAKOTACARE GROUP #" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: DD0976 . This is a "RR MEDICARE GROUP #" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4997309 . This is a "BC/BS GROUP #" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: P00304019 . This is a "RR PROVIDER #" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6540133 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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