1134463433 NPI number — MARGARET L SOUTHARD SP ED

Table of content: MARGARET L SOUTHARD SP ED (NPI 1134463433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134463433 NPI number — MARGARET L SOUTHARD SP ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUTHARD
Provider First Name:
MARGARET
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SP ED
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:
1134463433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
171 INTREPID LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13205-2548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-437-4698
Provider Business Mailing Address Fax Number:
315-437-4689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5962 RT 31
Provider Second Line Business Practice Location Address:
SUITE 7 BOX 10
Provider Business Practice Location Address City Name:
CICERO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-698-0033
Provider Business Practice Location Address Fax Number:
315-698-0031
Provider Enumeration Date:
11/27/2012

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1104109016 . This is a "ORGANIZATION NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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