1336238112 NPI number — M S TIGER INCORPORATED

Table of content: (NPI 1336238112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336238112 NPI number — M S TIGER INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M S TIGER INCORPORATED
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:
DBA HARRIS MEDICAL
Provider Other Organization Name Type Code:
3
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:
1336238112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
63 MARKET ST
Provider Second Line Business Mailing Address:
P.O. BOX 663
Provider Business Mailing Address City Name:
POTSDAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13676-1779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-265-0623
Provider Business Mailing Address Fax Number:
315-268-0750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTSDAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13676-1870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-265-0623
Provider Business Practice Location Address Fax Number:
315-268-0750
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
MARY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
315-265-0623

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01406817 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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