1851441844 NPI number — MRS. JANE E WISSE-GOETZ MSPT

Table of content: MRS. JANE E WISSE-GOETZ MSPT (NPI 1851441844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851441844 NPI number — MRS. JANE E WISSE-GOETZ MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISSE-GOETZ
Provider First Name:
JANE
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
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:
1851441844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2517 7TH AVE S
Provider Second Line Business Mailing Address:
SUITE A-1
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59405-3032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-771-0777
Provider Business Mailing Address Fax Number:
406-771-0776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2517 7TH AVE S
Provider Second Line Business Practice Location Address:
SUITE A-1
Provider Business Practice Location Address City Name:
GREAT FALLS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59405-3032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-771-0777
Provider Business Practice Location Address Fax Number:
406-771-0776
Provider Enumeration Date:
01/11/2007

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:  207PT , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00096023 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 3400553 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com