1043382674 NPI number — MR. RONALD F FALCH CRNA

Table of content: MR. RONALD F FALCH CRNA (NPI 1043382674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043382674 NPI number — MR. RONALD F FALCH CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FALCH
Provider First Name:
RONALD
Provider Middle Name:
F
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1043382674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36681 WILDERNEST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRAIRIE DU CHIEN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53821-8891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-326-8368
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 E TAYLOR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRAIRIE DU CHIEN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53821-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-357-2000
Provider Business Practice Location Address Fax Number:
608-357-2254
Provider Enumeration Date:
11/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  61903030 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0944181 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43272400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".