1801874870 NPI number — MRS. GRETCHEN M. HIESTERMAN COBLE PT

Table of content: MRS. GRETCHEN M. HIESTERMAN COBLE PT (NPI 1801874870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801874870 NPI number — MRS. GRETCHEN M. HIESTERMAN COBLE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COBLE
Provider First Name:
GRETCHEN
Provider Middle Name:
M. HIESTERMAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HIESTERMAN
Provider Other First Name:
GRETCHEN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801874870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 SADDLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELENA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-457-0480
Provider Business Mailing Address Fax Number:
406-457-0481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 SADDLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-457-0480
Provider Business Practice Location Address Fax Number:
406-457-0481
Provider Enumeration Date:
01/09/2006

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: 225100000X , with the licence number:  1004 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 3076 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3401112 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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