1942362025 NPI number — SUSAN MARY QUINN HURST OTR/L, BCP

Table of content: SUSAN MARY QUINN HURST OTR/L, BCP (NPI 1942362025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942362025 NPI number — SUSAN MARY QUINN HURST OTR/L, BCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUINN HURST
Provider First Name:
SUSAN
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, BCP
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:
1942362025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2546
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDPOINT
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83864-0917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-263-6348
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDPOINT
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83864-1832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-304-0652
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2006

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: 225X00000X , with the licence number:  1265 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201752356 . This is a "TAX ID" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: OT00000844 . This is a "OT LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: OT-816 . This is a "OT LICENSE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: OT4752 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com