1841393402 NPI number — MRS. SARA PEUGH MSW LISW

Table of content: MRS. SARA PEUGH MSW LISW (NPI 1841393402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841393402 NPI number — MRS. SARA PEUGH MSW LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEUGH
Provider First Name:
SARA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ELLER-PEUGH
Provider Other First Name:
SARA
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW LISW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841393402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 44970
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIO RANCHO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-899-2911
Provider Business Mailing Address Fax Number:
505-898-1173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3615 SR 528
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-899-2911
Provider Business Practice Location Address Fax Number:
505-898-1173
Provider Enumeration Date:
09/07/2006

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: 1041C0700X , with the licence number:  I0144 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00R599 . This is a "BLUE CROSS BS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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