1164773289 NPI number — MR. ERNEST RAY HUHTA JR. CMAT, EASS

Table of content: MR. ERNEST RAY HUHTA JR. CMAT, EASS (NPI 1164773289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164773289 NPI number — MR. ERNEST RAY HUHTA JR. CMAT, EASS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUHTA
Provider First Name:
ERNEST
Provider Middle Name:
RAY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
CMAT, EASS
Provider Gender Code:
M

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:
1164773289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 264
Provider Second Line Business Mailing Address:
19- 3RD ST SE
Provider Business Mailing Address City Name:
MENAHGA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-564-4200
Provider Business Mailing Address Fax Number:
218-564-5711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19- 3RD ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENAHGA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-564-4200
Provider Business Practice Location Address Fax Number:
218-564-5711
Provider Enumeration Date:
09/28/2012

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: 247200000X , with the licence number:  NO LICENSURE , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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