1457567679 NPI number — BONNIE RAE LANKFORD RMT

Table of content: BONNIE RAE LANKFORD RMT (NPI 1457567679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457567679 NPI number — BONNIE RAE LANKFORD RMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANKFORD
Provider First Name:
BONNIE
Provider Middle Name:
RAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RMT
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:
1457567679
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:
412 2ND AVE W
Provider Second Line Business Mailing Address:
BOX 87
Provider Business Mailing Address City Name:
DODSON
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-383-4339
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 GROS VENTRE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLEM
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-353-3100
Provider Business Practice Location Address Fax Number:
406-353-3229
Provider Enumeration Date:
05/15/2007

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: 246RM2200X , with the licence number:  584 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 76037 . This is a "AMT LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 584 . This is a "LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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