1548339807 NPI number — MR. CARMINE TRINGOLO RN, CRNFA

Table of content: MR. CARMINE TRINGOLO RN, CRNFA (NPI 1548339807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548339807 NPI number — MR. CARMINE TRINGOLO RN, CRNFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRINGOLO
Provider First Name:
CARMINE
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RN, CRNFA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRINGOLO
Provider Other First Name:
TONY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, CRNFA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1548339807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 W HARVARD AVE
Provider Second Line Business Mailing Address:
PMB 5205
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97470-2923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-672-4398
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
858 CLEVELAND HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97470-9614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-672-4398
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2006

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: 163WR0006X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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