1437323334 NPI number — JOSEPH J. OLIVER MD,PC

Table of content: (NPI 1437323334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437323334 NPI number — JOSEPH J. OLIVER MD,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH J. OLIVER MD,PC
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:
1437323334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1204 HILLTOP DR
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
ROCK SPRINGS
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82901-5861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-362-7745
Provider Business Mailing Address Fax Number:
307-382-6615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1204 HILLTOP DR
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ROCK SPRINGS
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82901-5861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-362-7745
Provider Business Practice Location Address Fax Number:
307-382-6615
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVER
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
307-362-7745

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  2629A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 106379101 . This is a "MEDICAID SUPPLY NUMBER" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 106379100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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