1558327643 NPI number — ANN R POWELL CNM

Table of content: ANN R POWELL CNM (NPI 1558327643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558327643 NPI number — ANN R POWELL CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
ANN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOW
Provider Other First Name:
ANN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1558327643
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:
800 CARTER ST
Provider Second Line Business Mailing Address:
ATTN KELLY STEELE
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-339-4793
Provider Business Mailing Address Fax Number:
585-336-4845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 EMPIRE DR
Provider Second Line Business Practice Location Address:
EMPIRE DRIVE HEALTH CENTER
Provider Business Practice Location Address City Name:
WEST SENECA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-668-6170
Provider Business Practice Location Address Fax Number:
716-656-4074
Provider Enumeration Date:
04/26/2006

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:  F0001211 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 159708CQ . This is a "PREFERRED CARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00325668 . This is a "MEDICARE RAILROAD #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000560350007 . This is a "HEALTH NOW BCBS #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426001914 . This is a "FIDELIS#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9513203 . This is a "IHA LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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