1174724108 NPI number — MS. CATHERINE MARIE JANUSZ PTA

Table of content: MS. CATHERINE MARIE JANUSZ PTA (NPI 1174724108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174724108 NPI number — MS. CATHERINE MARIE JANUSZ PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANUSZ
Provider First Name:
CATHERINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PTA
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:
1174724108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 438
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALICO ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72519-0438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-297-2403
Provider Business Mailing Address Fax Number:
870-297-4161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 GRASSE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALICO ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72519-0438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-297-2403
Provider Business Practice Location Address Fax Number:
870-297-4161
Provider Enumeration Date:
05/29/2007

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: 225200000X , with the licence number:  PTA 1598 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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