1932584653 NPI number — ANDRUMEDIA ARTI FIELD PA-C

Table of content: ANDRUMEDIA ARTI FIELD PA-C (NPI 1932584653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932584653 NPI number — ANDRUMEDIA ARTI FIELD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIELD
Provider First Name:
ANDRUMEDIA
Provider Middle Name:
ARTI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1932584653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 BUTTERFIELD RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-1069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-725-2730
Provider Business Mailing Address Fax Number:
844-205-5691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 ALBANY TPKE STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06019-2549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-693-4060
Provider Business Practice Location Address Fax Number:
860-693-6435
Provider Enumeration Date:
07/23/2015

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: 363A00000X , with the licence number:  003386 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003386 . This is a "CT STATE LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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