1770732570 NPI number — TERESA E. KLAINER,M.D.,PLLC

Table of content: (NPI 1770732570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770732570 NPI number — TERESA E. KLAINER,M.D.,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERESA E. KLAINER,M.D.,PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1770732570
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1018 SIXTH AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
PICAYUNE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39466-3837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-799-3011
Provider Business Mailing Address Fax Number:
601-799-4586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1018 SIXTH AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PICAYUNE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39466-3837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-799-3011
Provider Business Practice Location Address Fax Number:
601-799-4586
Provider Enumeration Date:
09/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KLAINER
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
ELENA
Authorized Official Title or Position:
CHIEF OFFICER
Authorized Official Telephone Number:
601-799-3011

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  20311 , 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)

  • Identifier: 1540668 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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