1396714630 NPI number — WAYNE H CARR DC

Table of content: WAYNE H CARR DC (NPI 1396714630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396714630 NPI number — WAYNE H CARR DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARR
Provider First Name:
WAYNE
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

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:
1396714630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2065 CAMPBELL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57350-3433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-352-5264
Provider Business Mailing Address Fax Number:
605-352-9776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2065 CAMPBELL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57350-3433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-352-5264
Provider Business Practice Location Address Fax Number:
605-352-9776
Provider Enumeration Date:
03/17/2006

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: 111N00000X , with the licence number:  704 , 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: 0080146 . This is a "BSSD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 460408441 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4999856 . This is a "BSSD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 512487 . This is a "AMPPO" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 7603433 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0086554 . This is a "BSSD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 27937 . This is a "SVHP" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 7603430 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7603432 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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