1639190507 NPI number — MS. MARSHA LYNNE KIRCHNER L.C.P.C.

Table of content: MS. MARSHA LYNNE KIRCHNER L.C.P.C. (NPI 1639190507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639190507 NPI number — MS. MARSHA LYNNE KIRCHNER L.C.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRCHNER
Provider First Name:
MARSHA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.P.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:
1639190507
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 335
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59806-0335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-728-8458
Provider Business Mailing Address Fax Number:
406-721-5234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 KENSINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE LL3
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59801-5674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-728-8458
Provider Business Practice Location Address Fax Number:
406-721-5234
Provider Enumeration Date:
07/23/2006

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: 101YP2500X , with the licence number:  378 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001037783 . This is a "MHN SERVICES PROVIDER NO." identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 134838 . This is a "COMPSYCH CORP. PROVIDER" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0251914 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005456426 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 74473 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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