1497861454 NPI number — RIMA KITTLEY, MD

Table of content: (NPI 1497861454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497861454 NPI number — RIMA KITTLEY, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIMA KITTLEY, MD
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:
1497861454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 152405
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUFKIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75915-2405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-634-5699
Provider Business Mailing Address Fax Number:
936-634-5659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 HANKS ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
LUFKIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75904-5411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-634-5699
Provider Business Practice Location Address Fax Number:
936-634-5659
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KITTLEY
Authorized Official First Name:
RIMA
Authorized Official Middle Name:
Z
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
936-634-5699

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  J7018 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 161159202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8X6840 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0070PG . This is a "BCBS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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