1588628994 NPI number — MRS. JUDITH ANN SMITH CCC A

Table of content: MRS. JUDITH ANN SMITH CCC A (NPI 1588628994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588628994 NPI number — MRS. JUDITH ANN SMITH CCC A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
JUDITH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CCC A
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:
1588628994
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 E 13TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-233-1367
Provider Business Mailing Address Fax Number:
515-233-1012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 E 13TH ST
Provider Second Line Business Practice Location Address:
HEARING UNLIMITED
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-233-1367
Provider Business Practice Location Address Fax Number:
515-233-1012
Provider Enumeration Date:
04/13/2006

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: 231H00000X , with the licence number:  251 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237600000X , with the licence number: 126 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0027821 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com