1033205687 NPI number — CHRISTINE DRIVDAHL-SMITH MD

Table of content: CHRISTINE DRIVDAHL-SMITH MD (NPI 1033205687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033205687 NPI number — CHRISTINE DRIVDAHL-SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRIVDAHL-SMITH
Provider First Name:
CHRISTINE
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:
1033205687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 S 7TH ST
Provider Second Line Business Mailing Address:
SUITE 241
Provider Business Mailing Address City Name:
MILES CITY
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59301-3216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-234-1420
Provider Business Mailing Address Fax Number:
406-234-1423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 S 7TH ST
Provider Second Line Business Practice Location Address:
SUITE 241
Provider Business Practice Location Address City Name:
MILES CITY
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59301-3216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-234-1420
Provider Business Practice Location Address Fax Number:
406-234-1423
Provider Enumeration Date:
10/04/2006

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:  8591 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0019720 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8591 . This is a "STATE LIC NUMBER" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 000099985 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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