1013070952 NPI number — VICKI THOMSON PA

Table of content: (NPI 1013070952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013070952 NPI number — VICKI THOMSON PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICKI THOMSON PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EDINA PEDIATRICS
Provider Other Organization Name Type Code:
3
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:
1013070952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7025 FRANCE AVE S STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-4215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-927-7337
Provider Business Mailing Address Fax Number:
952-927-8610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7380 FRANCE AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-4535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-927-7337
Provider Business Practice Location Address Fax Number:
952-927-8610
Provider Enumeration Date:
12/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMSON
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
952-927-7337

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  1101 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 106659 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 16745 . This is a "MHP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 932213200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49882ED . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8341265 . This is a "AETNA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".