1598717662 NPI number — DR. JEFFREY S RASCH DO

Table of content: DR. JEFFREY S RASCH DO (NPI 1598717662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598717662 NPI number — DR. JEFFREY S RASCH DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RASCH
Provider First Name:
JEFFREY
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1598717662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 HIGHLAND BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOZEMAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59715-6902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-414-1826
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BOBCAT CIRCLE
Provider Second Line Business Practice Location Address:
MSU CLINIC
Provider Business Practice Location Address City Name:
BOZEMAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-414-4780
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2006

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: 207QS0010X , with the licence number:  59970 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0010X , with the licence number: 11792 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 57672501204 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 807165900 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 903343 . This is a "DMBA GRP 22" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000025083 . This is a "ALTIUS GRP 22" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 100506339 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84422 . This is a "PEHP GRP 22" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 0000093458 . This is a "BCBS OF MONTANA" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 121126900 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 57672501200001 . This is a "BCBS GRP 22" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: D6127 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0143327 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90080 . This is a "U HEALTH PLANS GRP22" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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