1043240526 NPI number — DR. PAMELA J CHRISTY D.O.

Table of content: DR. PAMELA J CHRISTY D.O. (NPI 1043240526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043240526 NPI number — DR. PAMELA J CHRISTY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTY
Provider First Name:
PAMELA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1043240526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 496
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52626-0496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-878-3524
Provider Business Mailing Address Fax Number:
319-878-3524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 S 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52626-9105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-878-3524
Provider Business Practice Location Address Fax Number:
319-878-3524
Provider Enumeration Date:
07/03/2006

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:  02251 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0269662 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26966 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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