1629394630 NPI number — DR. HENRY ROBERTSON FAILING III HENRY FAILING

Table of content: DR. HENRY ROBERTSON FAILING III HENRY FAILING (NPI 1629394630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629394630 NPI number — DR. HENRY ROBERTSON FAILING III HENRY FAILING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAILING
Provider First Name:
HENRY
Provider Middle Name:
ROBERTSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
HENRY FAILING
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:
1629394630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2172
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SISTERS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97759-2172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-549-6766
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 SE HIGH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MITCHELL
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97750-0217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-462-3310
Provider Business Practice Location Address Fax Number:
541-763-2850
Provider Enumeration Date:
04/15/2010

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: 1223G0001X , with the licence number:  D4580 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com