1427397389 NPI number — MRS. VICKIE LYNN BURCHATZ COTA

Table of content: MRS. VICKIE LYNN BURCHATZ COTA (NPI 1427397389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427397389 NPI number — MRS. VICKIE LYNN BURCHATZ COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURCHATZ
Provider First Name:
VICKIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
COTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERENS
Provider Other First Name:
VICKIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427397389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 FOURTH AVENUE NE
Provider Second Line Business Mailing Address:
GOLDEN LIVING CENTER
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-886-8431
Provider Business Mailing Address Fax Number:
605-753-7801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 FOURTH AVENUE NE
Provider Second Line Business Practice Location Address:
GOLDEN LIVING CENTER
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-886-8431
Provider Business Practice Location Address Fax Number:
605-753-7801
Provider Enumeration Date:
02/12/2013

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: 224Z00000X , with the licence number:  SD147A , 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)





Copyright © 2007-2025 www.npivalidator.com