1215045885 NPI number — JENNIFER L WELSH MD

Table of content: JENNIFER L WELSH MD (NPI 1215045885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215045885 NPI number — JENNIFER L WELSH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELSH
Provider First Name:
JENNIFER
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1215045885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1151 SILVER LAKE RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRIGHTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55112-6324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-706-4500
Provider Business Mailing Address Fax Number:
612-781-6830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1151 SILVER LAKE RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRIGHTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55112-6324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-706-4500
Provider Business Practice Location Address Fax Number:
612-781-6830
Provider Enumeration Date:
08/25/2006

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:  39275 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QH0002X , with the licence number: 39275 , 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: 0556696 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1017646 . This is a "PREFERRED ONE NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 796807 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 10G23WE . This is a "BCBS MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP27176 . This is a "HEALTHPARTNERS NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 112848 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 32599600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01-16224 . This is a "MEDICA CHOICE & DUAL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 602879900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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