1235407834 NPI number — MR. ERIC DOUGLAS THUNSTEDT MA, CES, RCEP

Table of content: MR. ERIC DOUGLAS THUNSTEDT MA, CES, RCEP (NPI 1235407834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235407834 NPI number — MR. ERIC DOUGLAS THUNSTEDT MA, CES, RCEP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THUNSTEDT
Provider First Name:
ERIC
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA, CES, RCEP
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:
1235407834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
507 S. MAIN STREET
Provider Second Line Business Mailing Address:
VERNON MEMORIAL HEALTHCARE
Provider Business Mailing Address City Name:
VIROQUA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54665-2059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-637-4497
Provider Business Mailing Address Fax Number:
608-638-5023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
507 S. MAIN STREET
Provider Second Line Business Practice Location Address:
VERNON MEMORIAL HEALTHCARE
Provider Business Practice Location Address City Name:
VIROQUA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54665-2059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-637-4497
Provider Business Practice Location Address Fax Number:
608-638-5023
Provider Enumeration Date:
12/09/2011

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: 224Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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