1578915898 NPI number — RC DOBROWOLSKI PC

Table of content: (NPI 1578915898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578915898 NPI number — RC DOBROWOLSKI PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RC DOBROWOLSKI PC
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:
1578915898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6700 N LINDER RD STE 156
Provider Second Line Business Mailing Address:
MB 288
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83646-6608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-453-3799
Provider Business Mailing Address Fax Number:
702-453-5741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2131 S BONITO WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83642-1659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-453-3799
Provider Business Practice Location Address Fax Number:
702-453-5741
Provider Enumeration Date:
07/11/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOBROWOLSKI
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
903-520-8810

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  M-13291 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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