1285142943 NPI number — SELKIRK ENDOCRINOLOGY, PLLC

Table of content: (NPI 1285142943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285142943 NPI number — SELKIRK ENDOCRINOLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SELKIRK ENDOCRINOLOGY, PLLC
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:
6
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:
1285142943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3482
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POST FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83877-3482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1125 E POLSTON AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-6045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-758-0075
Provider Business Practice Location Address Fax Number:
208-758-0076
Provider Enumeration Date:
01/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HANSEN
Authorized Official First Name:
CHELSEY
Authorized Official Middle Name:
RENE
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
208-758-0075

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ========= . This is a "TAX ID NUMBER" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com