1942507660 NPI number — GENITA ANGEL

Table of content: GENITA ANGEL (NPI 1942507660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942507660 NPI number — GENITA ANGEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANGEL
Provider First Name:
GENITA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1942507660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2448 N MERRIT CREEK LOOP
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
COEUR D ALENE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83814-4953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-664-2901
Provider Business Mailing Address Fax Number:
208-667-9266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2448 N MERRIT CREEK LOOP
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-4953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-664-2901
Provider Business Practice Location Address Fax Number:
208-667-9266
Provider Enumeration Date:
02/15/2011

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: 225100000X , with the licence number:  PT-258 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 185598800 . This is a "FEDERAL L&I" identifier . This identifiers is of the category "OTHER".
  • Identifier: M0026441 171096043 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5003984 . This is a "REGENCE MED ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: QMXPR0060660 . This is a "MOLINA" identifier . This identifiers is of the category "OTHER".
  • Identifier: TID 91051 NPI . This is a "GROUP HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 82 0534955 . This is a "ID STATE INSURANCE FUND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 82 0534955 . This is a "IPN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 82 0534955 . This is a "STERLING MEDADV" identifier . This identifiers is of the category "OTHER".
  • Identifier: T9784 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 100000120993 . This is a "REGENCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: TID NPI SSN . This is a "FIRST CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000010026877 . This is a "REGENCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0063788 . This is a "WA L&I" identifier . This identifiers is of the category "OTHER".
  • Identifier: 82 053495583814A001 . This is a "TRIWEST/TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DA3588 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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