1275731077 NPI number — MRS. MELANIE KIM RAFFENSPERGER OTRL

Table of content: MRS. MELANIE KIM RAFFENSPERGER OTRL (NPI 1275731077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275731077 NPI number — MRS. MELANIE KIM RAFFENSPERGER OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAFFENSPERGER
Provider First Name:
MELANIE
Provider Middle Name:
KIM
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLINGAN
Provider Other First Name:
MELANIE
Provider Other Middle Name:
KIM
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTRL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275731077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3593
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59403-3593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-216-5995
Provider Business Mailing Address Fax Number:
406-216-5935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2509 7TH AVE S
Provider Second Line Business Practice Location Address:
SUITE C4
Provider Business Practice Location Address City Name:
GREAT FALLS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59405-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-216-5995
Provider Business Practice Location Address Fax Number:
406-216-5935
Provider Enumeration Date:
07/03/2007

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: 225X00000X , with the licence number:  1019 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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