1902208127 NPI number — ESPRIT HEALTH AND WELLNESS, LLC

Table of content: (NPI 1902208127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902208127 NPI number — ESPRIT HEALTH AND WELLNESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESPRIT HEALTH AND WELLNESS, 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:
ESPRIT HEALTH CLINIC
Provider Other Organization Name Type Code:
3
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:
1902208127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 S CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIDNEY
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59270-4127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-488-5000
Provider Business Mailing Address Fax Number:
406-206-0193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIDNEY
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59270-4127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-488-5000
Provider Business Practice Location Address Fax Number:
406-206-0193
Provider Enumeration Date:
09/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
TRUDELL
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
406-488-5000

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  32580 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com