1144243833 NPI number — RACHEL L TOLLEFSRUD M.D.

Table of content: RACHEL L TOLLEFSRUD M.D. (NPI 1144243833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144243833 NPI number — RACHEL L TOLLEFSRUD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOLLEFSRUD
Provider First Name:
RACHEL
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREEN
Provider Other First Name:
RACHEL
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144243833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
502 2ND ST SW
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
WILLMAR
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56201-3365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-235-7232
Provider Business Mailing Address Fax Number:
320-231-8609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 2ND ST SW
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WILLMAR
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56201-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-235-7232
Provider Business Practice Location Address Fax Number:
320-231-8609
Provider Enumeration Date:
07/25/2006

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: 207Q00000X , with the licence number:  45721 , 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: 135201 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: P00245103 . This is a "RR MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 749418100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2378456 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 325101845 . This is a "PRIME WEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP55084 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 354G6GR . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01-21830 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: MR1081044146 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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