1275754525 NPI number — MRS. AMY REEDY-HUFFMAN CDM

Table of content: MRS. AMY REEDY-HUFFMAN CDM (NPI 1275754525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275754525 NPI number — MRS. AMY REEDY-HUFFMAN CDM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REEDY-HUFFMAN
Provider First Name:
AMY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CDM
Provider Gender Code:
F

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:
1275754525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 EAST END ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMER
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-299-0158
Provider Business Mailing Address Fax Number:
907-235-3691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 EAST END ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMER
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-299-0158
Provider Business Practice Location Address Fax Number:
907-235-3691
Provider Enumeration Date:
05/02/2007

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: 176B00000X , with the licence number:  51 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NM6093 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com