1790787026 NPI number — MR. FRANCIS THOMAS ZAKRAJSEK EMT-B, FF

Table of content: MR. FRANCIS THOMAS ZAKRAJSEK EMT-B, FF (NPI 1790787026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790787026 NPI number — MR. FRANCIS THOMAS ZAKRAJSEK EMT-B, FF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAKRAJSEK
Provider First Name:
FRANCIS
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
EMT-B, FF
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:
1790787026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3123 RUBBLE WAY
Provider Second Line Business Mailing Address:
APT A
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47909-5473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-870-0669
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7758 N 800 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47960-7452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-870-0669
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2005

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: 146N00000X , with the licence number:  91-59005 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: KD4NEK . This is a "AMATEUR RADIO LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61508 . This is a "FIREFIGHTER, BASIC" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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