1689641920 NPI number — NETTA STEWART

Table of content: NETTA STEWART (NPI 1689641920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689641920 NPI number — NETTA STEWART

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
NETTA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1689641920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 JOEL DR
Provider Second Line Business Mailing Address:
BLANCHFIELD ARMY COMMUNITY HOSPITAL
Provider Business Mailing Address City Name:
FT. CAMPBELL
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42223-5349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-798-8372
Provider Business Mailing Address Fax Number:
270-956-0180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 JOEL DR.
Provider Second Line Business Practice Location Address:
BLANCHFIELD ARMY COMMUNITY HOSPITAL
Provider Business Practice Location Address City Name:
FT. CAMPBELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42223-5349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-798-8372
Provider Business Practice Location Address Fax Number:
270-956-0180
Provider Enumeration Date:
03/07/2006

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: 163WC0200X , with the licence number:  RN0000081069 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163WC1600X , with the licence number: RN0000081069 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163WC0400X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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