1578719894 NPI number — MRS. TINA MARIE MYERS NA

Table of content: MRS. TINA MARIE MYERS NA (NPI 1578719894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578719894 NPI number — MRS. TINA MARIE MYERS NA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
TINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MYERS
Provider Other First Name:
TINA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS ED
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1578719894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 TRANSIT RD
Provider Second Line Business Mailing Address:
1211 TRANSIT RD.
Provider Business Mailing Address City Name:
ORCHARD PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14127-1481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-662-1242
Provider Business Mailing Address Fax Number:
716-662-1242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 TRANSIT RD
Provider Second Line Business Practice Location Address:
1211 TRANSIT AVE.
Provider Business Practice Location Address City Name:
ORCHARD PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14127-1481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-662-1242
Provider Business Practice Location Address Fax Number:
716-662-1242
Provider Enumeration Date:
08/18/2008

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: 171W00000X , with the licence number:  NA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171W00000X , with the licence number: NA , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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