1285186916 NPI number — BISMARCK NP PSYCHIATRIC SERVICES PLLC

Table of content: (NPI 1285186916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285186916 NPI number — BISMARCK NP PSYCHIATRIC SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BISMARCK NP PSYCHIATRIC SERVICES 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:
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:
1285186916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6332 MATILDA GAGE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CICERO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13039-7916
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:
6221 ROUTE 31
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
CICERO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-489-0347
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BARUTI
Authorized Official First Name:
VIOLET
Authorized Official Middle Name:
M
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
713-382-5890

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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