Healthcare Provider Details

I. General information

NPI: 1952523243
Provider Name (Legal Business Name): MERLE MCFADDEN SIMPSON RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180055 THOMAS DR
SCOTSBLUFF NE
69361
US

IV. Provider business mailing address

180055 THOMAS DR
SCOTSBLUFF NE
69361
US

V. Phone/Fax

Practice location:
  • Phone: 308-641-7994
  • Fax:
Mailing address:
  • Phone: 308-641-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number1532
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: