1770818056 NPI number — MR. PATRICK CHRISTOPHER KORTHUIS IDMT

Table of content: MR. PATRICK CHRISTOPHER KORTHUIS IDMT (NPI 1770818056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770818056 NPI number — MR. PATRICK CHRISTOPHER KORTHUIS IDMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORTHUIS
Provider First Name:
PATRICK
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
IDMT
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:
1770818056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
932 MEDICAL SQUADRON
Provider Second Line Business Mailing Address:
2400 EAST DR. BLDG 3650
Provider Business Mailing Address City Name:
SCOTT AFB
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-229-7221
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 EAST DR
Provider Second Line Business Practice Location Address:
BLDG 3650 RM 135
Provider Business Practice Location Address City Name:
SCOTT AFB
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62225-5408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-229-7221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2009

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: 1710I1003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com