NPI |
1376057596 |
The city name in the location address of the provider being identified. |
Entity Type Code |
1 |
The State code in the location of the provider
being identified. |
Provider Last Name Legal Name |
DICKEY |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider First Name |
SARAH |
The country code in the location address of the provider being identified. |
Provider Middle Name |
KATHLEEN |
The middle name of the provider, if the provider
is an individual. |
Provider First Line Business Practice Location Address |
133 N 5TH ST #1 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
COLUMBUS |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MT |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
59106 |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The first name of the authorized official. |
Provider Business Practice Location Address Telephone Number |
4063225652 |
The middle name of the authorized official. |
Provider Business Practice Location Address Fax Number |
4063224960 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
11/27/2017 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
11/27/2017 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Gender Code |
F |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Healthcare Provider Taxonomy Code 1 |
183500000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number 1 |
5237 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
MT |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Is Sole Proprietor |
Y |
|