1891850814 NPI number — JULEE RICHARDS MD PC

Table of content: (NPI 1891850814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891850814 NPI number — JULEE RICHARDS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JULEE RICHARDS MD PC
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:
1891850814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
341 MEDICAL LOOP
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97471-5546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-440-2165
Provider Business Mailing Address Fax Number:
541-440-8932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
341 MEDICAL LOOP
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97471-5546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-440-2165
Provider Business Practice Location Address Fax Number:
541-440-8932
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDS
Authorized Official First Name:
JULEE
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
541-440-2165

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  MD17078 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 070016168 . This is a "RR MEDICARE PIN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: R112629 . This is a "MEDICARE INDIVIDUAL PIN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 804708001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: CJ9890 . This is a "RR MEDICARE GROUP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 026463 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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