1164736633 NPI number — IPH SECURITY SYSTEMS, INC

Table of content: MAYNARD ROBERT OLSEN M.D. (NPI 1518067347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164736633 NPI number — IPH SECURITY SYSTEMS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IPH SECURITY SYSTEMS, INC
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:
1164736633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7074
Provider Second Line Business Mailing Address:
706 6TH STREET
Provider Business Mailing Address City Name:
BROOKINGS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-469-7994
Provider Business Mailing Address Fax Number:
541-469-9359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKINGS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97415-9651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-469-7994
Provider Business Practice Location Address Fax Number:
541-469-9359
Provider Enumeration Date:
07/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CUTTING
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
KENNETH
Authorized Official Title or Position:
CAPTAIN/PRESIDENT
Authorized Official Telephone Number:
541-469-7994

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500607015 . This is a "DMAP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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