1811953144 NPI number — JAMIE S MCMURTREY MPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811953144 NPI number — JAMIE S MCMURTREY MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMURTREY
Provider First Name:
JAMIE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARRIS
Provider Other First Name:
JAMIE
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811953144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5622 SHERIDAN LAKE RD
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
RAPID CITY
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57702-8881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-773-8533
Provider Business Mailing Address Fax Number:
307-635-7578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1951 BLUEGRASS CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEYENNE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82009-7355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-773-8533
Provider Business Practice Location Address Fax Number:
307-635-7578
Provider Enumeration Date:
04/25/2006

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:  1887 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: BC/BS . This is a "313961" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: RAILROAD MEDICARE . This is a "P00271401" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 114566500 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com