1144235904 NPI number — RYAN LAGODINSKI DPT

Table of content: RYAN LAGODINSKI DPT (NPI 1144235904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144235904 NPI number — RYAN LAGODINSKI DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAGODINSKI
Provider First Name:
RYAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1144235904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKES
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58474-0368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-742-3267
Provider Business Mailing Address Fax Number:
701-742-3201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 SOUTH 7TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKES
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58474-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-742-3267
Provider Business Practice Location Address Fax Number:
701-742-3201
Provider Enumeration Date:
07/30/2006

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: 225100000X , with the licence number:  1423 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 27204 . This is a "BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 27206 . This is a "BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 27201 . This is a "BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 27203 . This is a "BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: P00341184 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 27205 . This is a "BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 51390 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: CG3429 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 27202 . This is a "BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 27207 . This is a "BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".