1821163734 NPI number — MRS. SUSAN M. BANKS

Table of content: MRS. SUSAN M. BANKS (NPI 1821163734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821163734 NPI number — MRS. SUSAN M. BANKS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANKS
Provider First Name:
SUSAN
Provider Middle Name:
M.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1821163734
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2431
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORDOVA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99574-2431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-424-7792
Provider Business Mailing Address Fax Number:
907-424-7936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 COOPER RIVER HIGHWAY
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
CORDOVA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99574-2431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-424-4935
Provider Business Practice Location Address Fax Number:
907-424-7936
Provider Enumeration Date:
11/24/2006

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CM3359 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com