1912084740 NPI number — REDI CARE, P.C.

Table of content: (NPI 1912084740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912084740 NPI number — REDI CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDI CARE, P.C.
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:
1912084740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2610 S DOUGLAS HWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
GILLETTE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82718-6468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-685-2273
Provider Business Mailing Address Fax Number:
307-682-2727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2610 S DOUGLAS HWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
GILLETTE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82718-6468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-685-2273
Provider Business Practice Location Address Fax Number:
307-682-2727
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCKINSEY
Authorized Official First Name:
LORI
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PROVIDER - REGISTERED AGENT
Authorized Official Telephone Number:
307-685-2273

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 313181 . This is a "DR. K. PATEL BCBS" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 1730186255 . This is a "LORI MCKINSEY NPI" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 313182 . This is a "LORI MCKINSEY BCBS" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".