1598719064 NPI number — ROBERT D NITSCHELM MD

Table of content: ROBERT D NITSCHELM MD (NPI 1598719064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598719064 NPI number — ROBERT D NITSCHELM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NITSCHELM
Provider First Name:
ROBERT
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1598719064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 HERITAGE WAY STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901-3127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-752-8433
Provider Business Mailing Address Fax Number:
406-756-6768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 HERITAGE WAY STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALISPELL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59901-3127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-752-8433
Provider Business Practice Location Address Fax Number:
406-756-6768
Provider Enumeration Date:
05/20/2006

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: 207Q00000X , with the licence number:  4431 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 11780 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0005763 . This is a "WELLMARK" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 080155590 . This is a "RR MEDICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5610078 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4431 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5610075 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005747 . This is a "WELLMARK" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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