1184629727 NPI number — DR. CULLEY K CHRISTENSEN MD

Table of content: DR. CULLEY K CHRISTENSEN MD (NPI 1184629727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184629727 NPI number — DR. CULLEY K CHRISTENSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTENSEN
Provider First Name:
CULLEY
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1184629727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ALAMOS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87544-0129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-661-9118
Provider Business Mailing Address Fax Number:
505-661-9192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3917 WEST RD
Provider Second Line Business Practice Location Address:
SUITE 139
Provider Business Practice Location Address City Name:
LOS ALAMOS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87544-2275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-661-9118
Provider Business Practice Location Address Fax Number:
505-661-9192
Provider Enumeration Date:
06/20/2005

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: 207X00000X , with the licence number:  CDR.0001925 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: MD2011-0257 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5198914 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 592161 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0265290 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 598184 . This is a "GREAT WEST HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: A002 . This is a "TRI CARE WEST REGION" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0545630001 . This is a "DME NATIONAL SUPPLIER NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 4021841 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z9392 . This is a "HEALTH NET MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 378534900 . This is a "OHIO BOARD OF WORKMEN'S C" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 66890 . This is a "HUMANA GOLD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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