1962591669 NPI number — ELIZABETH CUMBY MD

Table of content: ELIZABETH CUMBY MD (NPI 1962591669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962591669 NPI number — ELIZABETH CUMBY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUMBY
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1962591669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 CASA BLANCA RD
Provider Second Line Business Mailing Address:
PO BOX 490
Provider Business Mailing Address City Name:
CASA BLANCA
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87007-1071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-552-6034
Provider Business Mailing Address Fax Number:
505-552-7645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 MEDICINE HORSE DR.
Provider Second Line Business Practice Location Address:
PO BOX 3338
Provider Business Practice Location Address City Name:
TOHAJIILEE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87026-3338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-908-2307
Provider Business Practice Location Address Fax Number:
505-908-2310
Provider Enumeration Date:
10/12/2006

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: 207Q00000X , with the licence number:  89-22 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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