Healthcare Provider Details

I. General information

NPI: 1104047257
Provider Name (Legal Business Name): REYNALDO ALMADIN JORNACION MT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR1 BOX 67
HARLEM MT
59526
US

IV. Provider business mailing address

RR1 BOX 1602
HARLEM MT
59526
US

V. Phone/Fax

Practice location:
  • Phone: 406-353-3100
  • Fax: 406-353-3229
Mailing address:
  • Phone: 406-353-4754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number04040536
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: