Provider Demographics
NPI:1881827582
Name:TROMBLEY, JIM
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:TROMBLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 FRONTAGE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-9104
Mailing Address - Country:US
Mailing Address - Phone:907-283-0809
Mailing Address - Fax:
Practice Address - Street 1:805 FRONTAGE RD STE 208
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-9104
Practice Address - Country:US
Practice Address - Phone:907-283-0809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM6101OtherSTATE OF ALASKA