1508821653 NPI number — MS. HEIDI L ZINK CNM MS

Table of content: MS. HEIDI L ZINK CNM MS (NPI 1508821653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508821653 NPI number — MS. HEIDI L ZINK CNM MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZINK
Provider First Name:
HEIDI
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNM MS
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:
1508821653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MERCADO ST STE 145
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81301-7311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-247-5543
Provider Business Mailing Address Fax Number:
970-247-5545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MERCADO ST STE 145
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-7311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-247-5543
Provider Business Practice Location Address Fax Number:
970-247-5545
Provider Enumeration Date:
04/20/2006

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: 367A00000X , with the licence number:  124354 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367A00000X , with the licence number: 555 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 83900039 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84-1491843 . This is a "PRACTICE TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: MZ1355381 . This is a "FEDERAL CONTROLLED SUBSTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50439251 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: NM006984 . This is a "NM BCBS PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11749 . This is a "ACNM CERTIFICATION" identifier . This identifiers is of the category "OTHER".




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