1467670976 NPI number — KARIN WOOD

Table of content: KARIN WOOD (NPI 1467670976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467670976 NPI number — KARIN WOOD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
KARIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1467670976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 LINCOLN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEADWOOD
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57732-1453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
146 W. ILLINOIS ST., STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPEARFISH
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-722-8090
Provider Business Practice Location Address Fax Number:
605-722-8090
Provider Enumeration Date:
04/22/2007

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 534 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4996117 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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