1497865893 NPI number — MONTGOMERY OTOLARYNGOLOGY LLP

Table of content: JILLIAN MARIE KUCSKAR LMHC (NPI 1295037794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497865893 NPI number — MONTGOMERY OTOLARYNGOLOGY LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY OTOLARYNGOLOGY LLP
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:
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:
1497865893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1722 PINE ST
Provider Second Line Business Mailing Address:
SUITE 804
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36106-1103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-834-7221
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1722 PINE ST
Provider Second Line Business Practice Location Address:
SUITE 804
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36106-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-834-7221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EGELAND
Authorized Official First Name:
RODGER
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
334-834-7221

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 528801560 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: D507 . This is a "MEDICARE PTAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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