1710262761 NPI number — MS. MEGAN L LACROSS B.A.

Table of content: MS. MEGAN L LACROSS B.A. (NPI 1710262761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710262761 NPI number — MS. MEGAN L LACROSS B.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LACROSS
Provider First Name:
MEGAN
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
B.A.
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:
1710262761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 331
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOLDOTNA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99669-0331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-262-7504
Provider Business Mailing Address Fax Number:
907-262-9422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44539 STERLING HWY
Provider Second Line Business Practice Location Address:
STE.206
Provider Business Practice Location Address City Name:
SOLDOTNA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99669-7938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-262-7504
Provider Business Practice Location Address Fax Number:
907-262-9422
Provider Enumeration Date:
10/20/2011

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: 171M00000X , with the licence number:  CMG632 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CMG632 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com