1417366576 NPI number — DR. RHONDA EICKHOLT MHAPRN P.C.

Table of content: (NPI 1417366576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417366576 NPI number — DR. RHONDA EICKHOLT MHAPRN P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. RHONDA EICKHOLT MHAPRN 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:
1417366576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3972 US HIGHWAY 93 N
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
STEVENSVILLE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59870-6494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-777-6958
Provider Business Mailing Address Fax Number:
406-777-5869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3972 US HIGHWAY 93 N
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
STEVENSVILLE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59870-6494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-777-6958
Provider Business Practice Location Address Fax Number:
406-777-5869
Provider Enumeration Date:
08/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
EICKHOLT
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-777-6958

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  MT37331 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0855X , with the licence number: MT37331 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1043599939 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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