1053407171 NPI number — MS. JOAN MARIE COLLINS OTR CHT

Table of content: MS. JOAN MARIE COLLINS OTR CHT (NPI 1053407171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053407171 NPI number — MS. JOAN MARIE COLLINS OTR CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
JOAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR CHT
Provider Gender Code:
F

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:
1053407171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7801 EAST BUSH LAKE RD.
Provider Second Line Business Mailing Address:
#320
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-831-5773
Provider Business Mailing Address Fax Number:
952-831-7224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7373 FRANCE AVENUE SOUTH
Provider Second Line Business Practice Location Address:
#509
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-830-0069
Provider Business Practice Location Address Fax Number:
612-925-1123
Provider Enumeration Date:
10/05/2006

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: 225X00000X , with the licence number:  100327 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 100327 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 411657919 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 791001 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 411657919 . This is a "SELECT CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6400669 . This is a "MEDICA PRIMARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103164 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0592790001 . This is a "ADMINASTAR FED DMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 140065700 . This is a "MA SUPPLIES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2G11600 . This is a "BLUE CROSS BLUE SHIE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 363345400 . This is a "MINNESOTA MEDICAL AS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP31392 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2G11600 . This is a "MCHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 411657919 . This is a "PATIENT CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6433664 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103164 . This is a "UCARE FOR SENIORS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 363345400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 670000004 . This is a "MINNESOTA MEDICARE" identifier . This identifiers is of the category "OTHER".




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