1619975216 NPI number — DR. LUKE CUTHERELL M.D.

Table of content: DR. LUKE CUTHERELL M.D. (NPI 1619975216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619975216 NPI number — DR. LUKE CUTHERELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUTHERELL
Provider First Name:
LUKE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1619975216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
709 4TH AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATFORD CITY
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58854-7628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-444-8746
Provider Business Mailing Address Fax Number:
701-842-4025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 KINGSLEY LN
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23505-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-889-6500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2005

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: 208600000X , with the licence number:  19881 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 600021633 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 42731 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 453064 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 296571 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7398603 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".