1760710990 NPI number — DR. ANITA WACHT BATMAN MD

Table of content: DR. ANITA WACHT BATMAN MD (NPI 1760710990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760710990 NPI number — DR. ANITA WACHT BATMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BATMAN
Provider First Name:
ANITA
Provider Middle Name:
WACHT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1760710990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 W JEFFERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38930-3535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-455-9507
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIGHWAY 82 STUDENT HEALTH CLINIC
Provider Second Line Business Practice Location Address:
MISSISSIPPI VALLEY STATE UNIVERSITY
Provider Business Practice Location Address City Name:
ITTA BENA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-254-3331
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2009

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: 207Q00000X , with the licence number:  07962 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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