1225588858 NPI number — MR. RYAN MATTHEW ANLIKER I B.S.

Table of content: MR. RYAN MATTHEW ANLIKER I B.S. (NPI 1225588858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225588858 NPI number — MR. RYAN MATTHEW ANLIKER I B.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANLIKER
Provider First Name:
RYAN
Provider Middle Name:
MATTHEW
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
I
Provider Credential Text:
B.S.
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:
1225588858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18151 WILLIAMS HIGHWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97544-9634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-415-4602
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18151 WILLIAMS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97544-9644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-415-4602
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2016

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: 1744R1102X , with the licence number:  1683814-8 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 213ES0000X , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 302F00000X , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 305R00000X , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 305500000X , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 347C00000X , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 282NW0100X , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251T0000X , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3416AD800X , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25300000X , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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