1255326971 NPI number — JAY F STEINKE CRNA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255326971 NPI number — JAY F STEINKE CRNA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

STEINKE

Provider First Name:

JAY

Provider Middle Name:

F

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

CRNA

Provider Gender Code:

M

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:

1255326971

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/12/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

800 E 21ST ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SIOUX FALLS

Provider Business Mailing Address State Name:

SD

Provider Business Mailing Address Postal Code:

57105-1016

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

605-322-2754

Provider Business Mailing Address Fax Number:

605-322-2727

Provider First Line Business Practice Location Address:

800 E 21ST ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SIOUX FALLS

Provider Business Practice Location Address State Name:

SD

Provider Business Practice Location Address Postal Code:

57105-1016

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

605-322-2754

Provider Business Practice Location Address Fax Number:

605-322-2727

Provider Enumeration Date:

09/19/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 367500000X , with the licence number:  R022644 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 367500000X , with the licence number: R 125243-3 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: D-092532 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 0065245 . This is a "BLUE CROSS OF SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 1120337 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0040218 . This is a "WELLMARK" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 051K1ST . This is a "MN BLUECROSS BS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 5752043 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 5752044 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: R022644 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 2120337 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 46022474348 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 1255326971 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".