1861816084 NPI number — ANDREA CORDEIRO ATC, LMT

Table of content: ANDREA CORDEIRO ATC, LMT (NPI 1861816084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861816084 NPI number — ANDREA CORDEIRO ATC, LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORDEIRO
Provider First Name:
ANDREA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC, LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KNOCHE
Provider Other First Name:
ANDREA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861816084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ULM
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59485-0108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
157 ULM VAUGHN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ULM
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-788-0569
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2014

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: 174400000X , with the licence number:  ATR-LAT-LIC-20 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: LMT-LMT-LIC-1017 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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