1245674050 NPI number — RICHARD L SHELDON M D PROFESSIONAL CORPORATION

Table of content: MARCY IRENE COUCKUYT MA, LMHC (NPI 1891086120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245674050 NPI number — RICHARD L SHELDON M D PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD L SHELDON M D PROFESSIONAL CORPORATION
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:
1245674050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1829
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COEUR D ALENE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83816-1829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-209-0524
Provider Business Mailing Address Fax Number:
208-664-2341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 N CECIL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-262-2800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SHELDON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
LADD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-209-0524

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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