1073977864 NPI number — ALDER CLAY STEINBAUER RN

Table of content: ALDER CLAY STEINBAUER RN (NPI 1073977864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073977864 NPI number — ALDER CLAY STEINBAUER RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEINBAUER
Provider First Name:
ALDER
Provider Middle Name:
CLAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEINBAUER
Provider Other First Name:
AERYCA
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073977864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 MAPLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLYOKE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-420-2153
Provider Business Mailing Address Fax Number:
413-540-0957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLYOKE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-420-2200
Provider Business Practice Location Address Fax Number:
413-534-5416
Provider Enumeration Date:
04/08/2016

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: 163WC1500X , with the licence number:  RN2301768 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN2301768 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110027773 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".