1104043587 NPI number — NORTHSTAR CIRCLE OF COMPANIES, INC.

Table of content: (NPI 1104043587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104043587 NPI number — NORTHSTAR CIRCLE OF COMPANIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHSTAR CIRCLE OF COMPANIES, INC.
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:
NCC, INC.
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:
1104043587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8116
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55108-0116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2381 CARTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55108-1625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-646-0471
Provider Business Practice Location Address Fax Number:
651-646-0470
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEBER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
AUDIOLOGIST OWNER
Authorized Official Telephone Number:
651-646-0471

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  5331 , 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: 12696NO . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002228315002 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45-00015 . This is a "MEDICA (SALT LAKE CITY)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101102 . This is a "UCARE MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 634553100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6396 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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