1003278599 NPI number — MS. AMY CLOUDT CADC I

Table of content: MS. AMY CLOUDT CADC I (NPI 1003278599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003278599 NPI number — MS. AMY CLOUDT CADC I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLOUDT
Provider First Name:
AMY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CADC I
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:
1003278599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3425 13TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKER CITY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97814-1340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-523-7400
Provider Business Mailing Address Fax Number:
541-523-4927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKER CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-523-9559
Provider Business Practice Location Address Fax Number:
541-523-8067
Provider Enumeration Date:
03/23/2016

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: 101YA0400X , with the licence number:  19-03-31 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 14-09-02 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 500707005 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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