1922303155 NPI number — RICHARD S BUSWELL MD PC

Table of content: (NPI 1922303155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922303155 NPI number — RICHARD S BUSWELL MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD S BUSWELL 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:
1922303155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 WINNE AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
HELENA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59601-4900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-442-0507
Provider Business Mailing Address Fax Number:
406-442-0501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 WINNE AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-442-0507
Provider Business Practice Location Address Fax Number:
406-442-0501
Provider Enumeration Date:
01/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BUSWELL
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-442-0507

Provider Taxonomy Codes

  • Taxonomy code: 207KA0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0029562 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: M011100554 . This is a "PTAN" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com