1811960156 NPI number — DR. CARL JAY BODENSTEIN MD

Table of content: FRANK S AMATO ARNP (NPI 1417940347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811960156 NPI number — DR. CARL JAY BODENSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BODENSTEIN
Provider First Name:
CARL
Provider Middle Name:
JAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1811960156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 W 8TH AVE
Provider Second Line Business Mailing Address:
STE 336C
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99204-2302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-455-8855
Provider Business Mailing Address Fax Number:
509-455-8383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 W 8TH AVE
Provider Second Line Business Practice Location Address:
STE 336C
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-455-8855
Provider Business Practice Location Address Fax Number:
509-455-8383
Provider Enumeration Date:
02/08/2006

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: 2080N0001X , with the licence number:  MD00020651 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10004603 . This is a "REGENCE BLUE S. OF IDAHO" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911922781 . This is a "PHCO" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911922781 . This is a "CIGNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: BO6528 . This is a "ASURIS NW HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911922781 . This is a "PREMERA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911922781 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8458507 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: KA345 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 000038801 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205997 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000108137 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5404342 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911922781 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911922781 . This is a "GROUP HEALTH NW" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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