1174558860 NPI number — CATHERINE E BUTLER MD

Table of content: LIZETTE BONILLA LCSW (NPI 1043004229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174558860 NPI number — CATHERINE E BUTLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTLER
Provider First Name:
CATHERINE
Provider Middle Name:
E
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:
1174558860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
532 1ST ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRITT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50423-1227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-843-5050
Provider Business Mailing Address Fax Number:
641-843-5051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
532 1ST ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRITT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50423-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-843-5050
Provider Business Practice Location Address Fax Number:
641-843-5051
Provider Enumeration Date:
07/11/2006

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:  29072 , 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: 5092163 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15171 . This is a "WELLMARK - WESLEY CLINIC" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 4092163 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18053 . This is a "WELLMARK -BRITT CLINIC" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".