1801843214 NPI number — DR. SHARON KAY THARP OD

Table of content: DR. SHARON KAY THARP OD (NPI 1801843214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801843214 NPI number — DR. SHARON KAY THARP OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THARP
Provider First Name:
SHARON
Provider Middle Name:
KAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1801843214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 W 29TH ST
Provider Second Line Business Mailing Address:
STE 302
Provider Business Mailing Address City Name:
S SIOUX CITY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68776-3852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-494-5533
Provider Business Mailing Address Fax Number:
402-494-5534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 W 29TH ST
Provider Second Line Business Practice Location Address:
STE 302
Provider Business Practice Location Address City Name:
S SIOUX CITY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68776-3852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-494-5533
Provider Business Practice Location Address Fax Number:
402-494-5534
Provider Enumeration Date:
05/30/2006

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: 152W00000X , with the licence number:  996 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 47076275100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0392900001 . This is a "DMERC" identifier . This identifiers is of the category "OTHER".




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