1912947623 NPI number — MS. KRIS T BREAULT CTRS

Table of content: MS. KRIS T BREAULT CTRS (NPI 1912947623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912947623 NPI number — MS. KRIS T BREAULT CTRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREAULT
Provider First Name:
KRIS
Provider Middle Name:
T
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CTRS
Provider Gender Code:
F

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:
1912947623
Entity Type Code:
Individual
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:
319 GRANDVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANOLA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15051-1005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-767-0188
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VAPHCS
Provider Second Line Business Practice Location Address:
7180 HIGHLAND DRIVE
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-365-5855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2006

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: 225800000X , with the licence number:  15977 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15977 . This is a "CTRS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com