1184706251 NPI number — JEFFREY D PIERCE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184706251 NPI number — JEFFREY D PIERCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY D PIERCE
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:
SOUTHWEST ANESTHESIA SERVICE
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:
1184706251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 E 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACONIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55387-4552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-442-9770
Provider Business Mailing Address Fax Number:
952-442-3630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 COMPASSION WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DODGEVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53533-1956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-935-2711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
888-443-9902

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , 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: 39754747701 . This is a "UNITY HEALTH PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 43419200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com