1689617466 NPI number — JANET L MARGESON CRNA

Table of content: JANET L MARGESON CRNA (NPI 1689617466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689617466 NPI number — JANET L MARGESON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARGESON
Provider First Name:
JANET
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

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:
1689617466
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 E 20TH ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87401-9039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-326-6400
Provider Business Mailing Address Fax Number:
505-326-4606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 W MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87401-5630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-326-6400
Provider Business Practice Location Address Fax Number:
505-326-4606
Provider Enumeration Date:
06/13/2006

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: 367500000X , with the licence number:  R54519 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00442537 . This is a "RR MEDICARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 106865 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: T0515 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202008371 . This is a "PRESBYTERIAN HP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 14033399 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35209372 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10027982 . This is a "LOVELACE HP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM006E21 . This is a "BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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