1225222433 NPI number — DR. RONALD B TYE PSY.D.

Table of content: DR. RONALD B TYE PSY.D. (NPI 1225222433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225222433 NPI number — DR. RONALD B TYE PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYE
Provider First Name:
RONALD
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
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:
1225222433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6003 OVERLAND RD
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83709-3073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-672-8699
Provider Business Mailing Address Fax Number:
208-672-9308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6003 OVERLAND RD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83709-3073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-672-8699
Provider Business Practice Location Address Fax Number:
208-672-9308
Provider Enumeration Date:
08/30/2007

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:  PSY316 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: PSY3208 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 805455300 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000010017563 . This is a "BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: N5228 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1194837351 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com