1215129572 NPI number — OSTERMAN'S #2 INC

Table of content: MS. ERIN GERAGHTY R.N.C, M.S., N.P. (NPI 1295944916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215129572 NPI number — OSTERMAN'S #2 INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSTERMAN'S #2 INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1215129572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 905
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHASTA LAKE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96019-0905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-275-2346
Provider Business Mailing Address Fax Number:
530-275-6674

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2561 CAPELLA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96002-3447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-275-2346
Provider Business Practice Location Address Fax Number:
530-275-6674
Provider Enumeration Date:
08/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OSTERMAN
Authorized Official First Name:
DORIS
Authorized Official Middle Name:
SUSAN
Authorized Official Title or Position:
OWNER ADMISISTRATOR
Authorized Official Telephone Number:
530-275-2346

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LTC 60746G . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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