1497828081 NPI number — MS. KATHRYN JANE HALSTEAD MSTOM

Table of content: MS. KATHRYN JANE HALSTEAD MSTOM (NPI 1497828081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497828081 NPI number — MS. KATHRYN JANE HALSTEAD MSTOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALSTEAD
Provider First Name:
KATHRYN
Provider Middle Name:
JANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSTOM
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:
1497828081
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:
7904 PATHFINDER PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAPID CITY
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57702-9135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-721-4580
Provider Business Mailing Address Fax Number:
605-721-3944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2416 JACKSON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57702-3450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-721-4580
Provider Business Practice Location Address Fax Number:
605-721-4580
Provider Enumeration Date:
11/15/2006

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: 171100000X , 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)





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