1194835355 NPI number — DR. DAVID A BYRNE PSYD

Table of content: DR. DAVID A BYRNE PSYD (NPI 1194835355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194835355 NPI number — DR. DAVID A BYRNE PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYRNE
Provider First Name:
DAVID
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
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:
1194835355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 364
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-261-4100
Provider Business Mailing Address Fax Number:
920-261-8801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 W MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-261-4100
Provider Business Practice Location Address Fax Number:
920-261-8801
Provider Enumeration Date:
08/30/2006

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: 103TC0700X , with the licence number:  2193057 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13698 . This is a "DION HEALTH INS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 39184249618 . This is a "UNITY INSURANCE LAKE MILL" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 214888 . This is a "MHN INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 39184249617 . This is a "UNITY INSURANCE WATERTOWN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 39184249610 . This is a "JOHN DEERE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2002997 . This is a "PHYSICIANS PLUS INS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 6156673 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".




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