1750584173 NPI number — ROY E. PAULSON JR PC

Table of content: (NPI 1750584173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750584173 NPI number — ROY E. PAULSON JR PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROY E. PAULSON JR PC
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:
1750584173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 N. KENWOOD ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82601-2724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-266-1997
Provider Business Mailing Address Fax Number:
307-237-4424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 N. KENWOOD ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601-2724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-266-1997
Provider Business Practice Location Address Fax Number:
307-237-4424
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PAULSON
Authorized Official First Name:
ROY
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
PEDIATRIC DENTIST
Authorized Official Telephone Number:
307-266-1997

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112331900 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: A0H1301FUMCMEAT . This is a "CMS EHR CERTIFICATION" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com