1942407010 NPI number — JAMES E KONOPASEK M.S.

Table of content: JAMES E KONOPASEK M.S. (NPI 1942407010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942407010 NPI number — JAMES E KONOPASEK M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONOPASEK
Provider First Name:
JAMES
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
M

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:
1942407010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
502 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 206B
Provider Business Mailing Address City Name:
THE DALLES
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97058-2270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-490-7673
Provider Business Mailing Address Fax Number:
541-298-5653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 206B
Provider Business Practice Location Address City Name:
THE DALLES
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97058-2270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-490-7673
Provider Business Practice Location Address Fax Number:
541-298-5653
Provider Enumeration Date:
06/29/2007

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: 101Y00000X , with the licence number:  FC00000109 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 171W00000X , with the licence number: POLYG EXAMINER - 173 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 298043 . This is a "OMAP PROVIDER NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: L43392 . This is a "DHS PROVIDER NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 215538 . This is a "WA DSHS PROVIDER NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com