1659467538 NPI number — LINDA I GARRITY

Table of content: (NPI 1659467538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659467538 NPI number — LINDA I GARRITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINDA I GARRITY
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:
6
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:
1659467538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/13/2007
NPI Reactivation Date:
11/07/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 E MAIN ST
Provider Second Line Business Mailing Address:
SUITE 702
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53703-3395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-255-0100
Provider Business Mailing Address Fax Number:
608-251-2404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 702
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53703-3395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-255-0100
Provider Business Practice Location Address Fax Number:
608-251-2400
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARRITY
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
I
Authorized Official Title or Position:
COORDINATOR
Authorized Official Telephone Number:
608-255-0100

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 42143800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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