1821089061 NPI number — WAYNE M MILLS P.T.

Table of content: WAYNE M MILLS P.T. (NPI 1821089061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821089061 NPI number — WAYNE M MILLS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLS
Provider First Name:
WAYNE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

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:
1821089061
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:
9518 SCORPIO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83709-4745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-322-7660
Provider Business Mailing Address Fax Number:
208-362-4978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 W FRANKLIN RD
Provider Second Line Business Practice Location Address:
C/O COMMUNICARE
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83642-2965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-861-3648
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2005

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: 225100000X , with the licence number:  RPT-048 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: T-0387 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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