1952519548 NPI number — BACK TO HEALTH

Table of content: (NPI 1952519548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952519548 NPI number — BACK TO HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK TO HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1952519548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
248 3RD AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901-4532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-756-5985
Provider Business Mailing Address Fax Number:
406-756-7184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
248 3RD AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALISPELL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59901-4532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-756-5985
Provider Business Practice Location Address Fax Number:
406-756-7184
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BIGGS
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
406-756-5985

Provider Taxonomy Codes

  • Taxonomy code: 111NX0800X , with the licence number:  560 , 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: M011002252 . This is a "MEDICARE ID- TYPE UNSPECIFIED" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0163917 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 042190 . This is a "BLUE CROSS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: G7262 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0163914 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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