1285728022 NPI number — AMY L SIMANTEL MD

Table of content: AMY L SIMANTEL MD (NPI 1285728022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285728022 NPI number — AMY L SIMANTEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMANTEL
Provider First Name:
AMY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1285728022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N. WATER STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-862-1616
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N. WATER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-862-1616
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006

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: 207R00000X , with the licence number:  43064 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 12965 . This is a "DEAN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34152700 . This is a "HIRSP" identifier . This identifiers is of the category "OTHER".
  • Identifier: K13389 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14800226 . This is a "MEDICARE PART B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34152700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1038843 . This is a "PHYSICIANS PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 390808509C1 . This is a "UNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90002361 . This is a "WEA INS" identifier . This identifiers is of the category "OTHER".




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