1356394282 NPI number — CAROL J BORG CNP

Table of content: CAROL J BORG CNP (NPI 1356394282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356394282 NPI number — CAROL J BORG CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORG
Provider First Name:
CAROL
Provider Middle Name:
J
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:
1356394282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 537
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKAGWAY
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99840-0537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-983-2255
Provider Business Mailing Address Fax Number:
907-983-2793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 14TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKAGWAY
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99840-0537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-983-2255
Provider Business Practice Location Address Fax Number:
907-983-2793
Provider Enumeration Date:
05/19/2006

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: 363L00000X , with the licence number:  R024086 , 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)

  • Identifier: 3475 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6825703 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: NP0019 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0004772 . This is a "WELLMARK" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 0004792 . This is a "WELLMARK" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 9239542 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: P00352245 . This is a "RR MEDICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6825704 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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