1841370053 NPI number — ASPEN MANAGMENT SERVICES INC

Table of content: (NPI 1841370053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841370053 NPI number — ASPEN MANAGMENT SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPEN MANAGMENT SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1841370053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
645 S WOODRUFF AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IDAHO FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83401-5596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-552-9886
Provider Business Mailing Address Fax Number:
208-552-9843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
657 S WOODRUFF AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IDAHO FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83401-5596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-552-9886
Provider Business Practice Location Address Fax Number:
208-552-9843
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLAVESON
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
208-552-9886

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: TC126 . This is a "BLUE CROSS PROVIDER NO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010149844 . This is a "BLUE SHIELD PROVIDER NO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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