1891792685 NPI number — MRS. CHARISSA ANN AHLSTEDT O.T.

Table of content: MRS. CHARISSA ANN AHLSTEDT O.T. (NPI 1891792685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891792685 NPI number — MRS. CHARISSA ANN AHLSTEDT O.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHLSTEDT
Provider First Name:
CHARISSA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ORCHARD
Provider Other First Name:
CHARISSA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891792685
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:
2342 14TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDSBORG
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67456-5071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-227-8828
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCPHERSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67460-5735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-241-1825
Provider Business Practice Location Address Fax Number:
620-241-7135
Provider Enumeration Date:
07/07/2005

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: 225X00000X , with the licence number:  1701788 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 013626 . This is a "BCBS OF KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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