1306211040 NPI number — CYNTHIA ANN STOCKS CNP

Table of content: CYNTHIA ANN STOCKS CNP (NPI 1306211040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306211040 NPI number — CYNTHIA ANN STOCKS CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOCKS
Provider First Name:
CYNTHIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
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:
1306211040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MONUMENT HEALTH FAMILY MEDICINE
Provider Second Line Business Mailing Address:
640 FLORMANN STREET
Provider Business Mailing Address City Name:
RAPID CITY
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-755-3300
Provider Business Mailing Address Fax Number:
605-755-3129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MONUMENT HEALTH FAMILY MEDICINE
Provider Second Line Business Practice Location Address:
640 FLORMANN STREET
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-755-3300
Provider Business Practice Location Address Fax Number:
605-755-3129
Provider Enumeration Date:
12/07/2015

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: 363LF0000X , with the licence number:  SD-CNP CP000994 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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