1932441946 NPI number — THE BOARD OF TRUSTEES OF SIU GOVERNING SIUE

Table of content: YARIS L LOPEZ MONTALVO MSW (NPI 1922730407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932441946 NPI number — THE BOARD OF TRUSTEES OF SIU GOVERNING SIUE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BOARD OF TRUSTEES OF SIU GOVERNING SIUE
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:
6
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:
1932441946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
STUDENT SUCCESS CTR RM 0222
Provider Second Line Business Mailing Address:
CAMPUS BOX 1055
Provider Business Mailing Address City Name:
EDWARDSVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62026-1055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-650-2850
Provider Business Mailing Address Fax Number:
618-650-5839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STUDENT SUCCESS CTR RM 0222
Provider Second Line Business Practice Location Address:
CAMPUS BOX 1055
Provider Business Practice Location Address City Name:
EDWARDSVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62026-1055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-650-2850
Provider Business Practice Location Address Fax Number:
618-650-5839
Provider Enumeration Date:
03/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GREENWALT
Authorized Official First Name:
RIANE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
DIRECTOR, HEALTH SERVICE
Authorized Official Telephone Number:
618-650-2852

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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