1750362109 NPI number — DR. ERNEST L KISTLER MD

Table of content: DR. ERNEST L KISTLER MD (NPI 1750362109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750362109 NPI number — DR. ERNEST L KISTLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KISTLER
Provider First Name:
ERNEST
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1750362109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9600
Provider Second Line Business Mailing Address:
DEPT 09-039
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75505-9600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-214-8600
Provider Business Mailing Address Fax Number:
888-411-4191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SAINT MARY PL
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71101-4343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-214-8600
Provider Business Practice Location Address Fax Number:
888-411-4191
Provider Enumeration Date:
11/10/2005

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: 207L00000X , with the licence number:  014584 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1344877 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050016353 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".