1952455750 NPI number — AMY M FOSS D.C.

Table of content: AMY M FOSS D.C. (NPI 1952455750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952455750 NPI number — AMY M FOSS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSS
Provider First Name:
AMY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1952455750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1021 DAKOTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBBY
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59923-2207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-293-8736
Provider Business Mailing Address Fax Number:
406-293-8737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1021 DAKOTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBBY
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59923-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-293-8736
Provider Business Practice Location Address Fax Number:
406-293-8737
Provider Enumeration Date:
01/22/2007

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: 111N00000X , with the licence number:  0203511 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 1165 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7310F0 . This is a "ASURIS PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00284508 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 000010154052 . This is a "REGENCE OF ID PROV #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0203511 . This is a "LABOR & INDUSTRIES ID #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 98225 . This is a "AWHN PROVIDER ID" identifier . This identifiers is of the category "OTHER".




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