1477712214 NPI number — PARADISE VALLEY FIRE SERVICE AREA

Table of content: DR. STEPHEN ANDREW HENDERSON D.C. (NPI 1356428155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477712214 NPI number — PARADISE VALLEY FIRE SERVICE AREA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARADISE VALLEY FIRE SERVICE AREA
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:
Provider Other Organization Name Type Code:
6
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:
1477712214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1634
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMIGRANT
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59027-1634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-333-4357
Provider Business Mailing Address Fax Number:
406-333-4118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 EAST RIVER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRAY
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-333-4357
Provider Business Practice Location Address Fax Number:
406-333-4357
Provider Enumeration Date:
06/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OTIS
Authorized Official First Name:
BERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN OF BOARD OF TRUSTEES
Authorized Official Telephone Number:
406-333-4357

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  465 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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