1457550741 NPI number — MR. SHAWN MICHAEL RALPH CST/SA

Table of content: MR. SHAWN MICHAEL RALPH CST/SA (NPI 1457550741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457550741 NPI number — MR. SHAWN MICHAEL RALPH CST/SA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RALPH
Provider First Name:
SHAWN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CST/SA
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:
1457550741
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12630 W 67TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARVADA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80004-2217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-980-6808
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12630 W 67TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARVADA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80004-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-980-6808
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2007

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: 246Z00000X , with the licence number:  86896 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com