1871599118 NPI number — REG. NICHOLS SALES LLC

Table of content: (NPI 1871599118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871599118 NPI number — REG. NICHOLS SALES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REG. NICHOLS SALES LLC
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:
1871599118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 898
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEEKER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81641-0898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-878-5883
Provider Business Mailing Address Fax Number:
970-878-4736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
246 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEEKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81641-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-878-5883
Provider Business Practice Location Address Fax Number:
970-878-4736
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SULLIVAN
Authorized Official First Name:
BREN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
970-878-5883

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  325 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08003667 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com