1265539639 NPI number — DRS MOEN ENDERLE AND KREIN PC

Table of content: (NPI 1265539639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265539639 NPI number — DRS MOEN ENDERLE AND KREIN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS MOEN ENDERLE AND KREIN PC
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:
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:
1265539639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEVILS LAKE
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58301-0130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-662-4085
Provider Business Mailing Address Fax Number:
701-662-6685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 HWY 2 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEVILS LAKE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58301-0130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-4085
Provider Business Practice Location Address Fax Number:
701-662-6685
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOEN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
701-662-4085

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60573 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: CI2649 . This is a "PALMETTO GBA RAILROAD MEDICARE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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