1407845100 NPI number — JANICE M GARRY MA

Table of content: JANICE M GARRY MA (NPI 1407845100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407845100 NPI number — JANICE M GARRY MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARRY
Provider First Name:
JANICE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
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:
1407845100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 CENTER POINT RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52402-6571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-378-1199
Provider Business Mailing Address Fax Number:
319-378-7497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 CENTER POINT RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52402-6571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-378-1199
Provider Business Practice Location Address Fax Number:
319-378-7497
Provider Enumeration Date:
10/17/2005

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: 101YM0800X , with the licence number:  00760 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 234274 . This is a "MIDLANDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29464 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".