1033616230 NPI number — ARIEL FILLMORE MD

Table of content: ARIEL FILLMORE MD (NPI 1033616230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033616230 NPI number — ARIEL FILLMORE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FILLMORE
Provider First Name:
ARIEL
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:
1033616230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 RAILROAD ST W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59802-4109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-258-4789
Provider Business Mailing Address Fax Number:
406-258-4732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 RAILROAD ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59802-4109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-258-4789
Provider Business Practice Location Address Fax Number:
406-258-4732
Provider Enumeration Date:
04/12/2018

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:  12390020-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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