1134451156 NPI number — MARJORY RUTH PARRILL MT(ASCP)

Table of content: MARJORY RUTH PARRILL MT(ASCP) (NPI 1134451156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134451156 NPI number — MARJORY RUTH PARRILL MT(ASCP)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARRILL
Provider First Name:
MARJORY
Provider Middle Name:
RUTH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MT(ASCP)
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARRILL
Provider Other First Name:
MARGE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MT(ASCP)
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1134451156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 BLACK COAL ROAD
Provider Second Line Business Mailing Address:
P.O. BOX 128
Provider Business Mailing Address City Name:
FT. WASHAKIE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-332-7972
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 BLACK COAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT. WASHAKIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-332-7972
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2010

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: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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