1326024894 NPI number — MS. TAMMY LEIGH AUSTIN-KETCH NP

Table of content: MS. TAMMY LEIGH AUSTIN-KETCH NP (NPI 1326024894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326024894 NPI number — MS. TAMMY LEIGH AUSTIN-KETCH NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUSTIN-KETCH
Provider First Name:
TAMMY
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1326024894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3596 CURTISS AVE
Provider Second Line Business Mailing Address:
PO BOX 59
Provider Business Mailing Address City Name:
RANSOMVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14131-0059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-870-4668
Provider Business Mailing Address Fax Number:
716-829-2067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3003 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NIAGARA FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14305-1931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-284-8917
Provider Business Practice Location Address Fax Number:
716-284-0428
Provider Enumeration Date:
12/16/2005

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: 363LF0000X , with the licence number:  F331418 , 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)

  • Identifier: 000560260001 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000560260001 . This is a "CB" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026506601 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9511835 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01710838 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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