1366585994 NPI number — TIMOTHY J. RAMSDEN, M. D., P. C.

Table of content: (NPI 1366585994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366585994 NPI number — TIMOTHY J. RAMSDEN, M. D., P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMOTHY J. RAMSDEN, M. D., P. C.
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:
1366585994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4908
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83205-4908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-236-1600
Provider Business Mailing Address Fax Number:
208-236-6695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1151 HOSPITAL WAY # D
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-2763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-478-2472
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAMSDEN
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
208-478-2472

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  M-9314 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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