1902826951 NPI number — SENTER MEDICAL CLINIC, PC

Table of content: MRS. AMY RAPPORT FRANTZ CRNP (NPI 1699184747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902826951 NPI number — SENTER MEDICAL CLINIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENTER MEDICAL CLINIC, PC
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:
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:
1902826951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELMONT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38827-0549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-454-7170
Provider Business Mailing Address Fax Number:
662-454-7177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 THIRD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELMONT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-454-7170
Provider Business Practice Location Address Fax Number:
662-454-7177
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SENTER
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
662-454-7170

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  10171 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: K916 . This is a "MEDICARE GROUP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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