1770574741 NPI number — DR. BILL LEE HENNINGS PH.D.

Table of content: DR. BILL LEE HENNINGS PH.D. (NPI 1770574741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770574741 NPI number — DR. BILL LEE HENNINGS PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENNINGS
Provider First Name:
BILL
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1770574741
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
627 WINTER ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97301-2428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-931-5025
Provider Business Mailing Address Fax Number:
503-371-3839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
627 WINTER ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301-2428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-931-5025
Provider Business Practice Location Address Fax Number:
503-371-3839
Provider Enumeration Date:
10/31/2005

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: 103TC0700X , with the licence number:  0614 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 559447 . This is a "VALUE OPTIONS MHS#" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1770574741 . This is a "HEALTH NET" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 110791 . This is a "OMAP PROVIDER NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 906669 . This is a "SALEM HOSP MED STAFF ID #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: N54264777 . This is a "UBH PROVIDER ID" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 064073000 . This is a "REGENCE BC PROVIDER#" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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