1811904568 NPI number — MS. MELISSA L. TOMPKINS PA C

Table of content: MS. MELISSA L. TOMPKINS PA C (NPI 1811904568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811904568 NPI number — MS. MELISSA L. TOMPKINS PA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOMPKINS
Provider First Name:
MELISSA
Provider Middle Name:
L.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FULLER
Provider Other First Name:
MELISSA
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811904568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68446-0518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-269-2011
Provider Business Mailing Address Fax Number:
402-269-2795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2731 HEALTHCARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68446-7880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-269-2011
Provider Business Practice Location Address Fax Number:
402-269-3369
Provider Enumeration Date:
08/02/2006

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: 363A00000X , with the licence number:  960 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 37857 . This is a "BCBS OF NEBRASKA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com