1619990611 NPI number — VIRGINIA ELLEN CEYNAR P.A.-C

Table of content: VIRGINIA ELLEN CEYNAR P.A.-C (NPI 1619990611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619990611 NPI number — VIRGINIA ELLEN CEYNAR P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CEYNAR
Provider First Name:
VIRGINIA
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
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:
1619990611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 NORTH MAIN STREET
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-842-3771
Provider Business Mailing Address Fax Number:
701-842-4025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATFORD CITY
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-842-3771
Provider Business Practice Location Address Fax Number:
701-842-4025
Provider Enumeration Date:
07/25/2006

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: 363A00000X , with the licence number:  PAC0281 , 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: 108827102 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8361552 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 943987 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24633 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 4304366 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: NA4371043533 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 77063749858854A005 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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