1336443845 NPI number — NORTH CENTRAL CARAVANS, L.L.C.

Table of content: (NPI 1336443845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336443845 NPI number — NORTH CENTRAL CARAVANS, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CENTRAL CARAVANS, L.L.C.
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:
TODD AND TAMMIE ZINDA D.B.A. NORTH CENTRAL CARAVANS
Provider Other Organization Name Type Code:
4
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:
1336443845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N914 CTY HWY D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANTIGO
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54409-9079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-623-2229
Provider Business Mailing Address Fax Number:
715-623-4013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
719 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTIGO
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54409-2042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-623-2229
Provider Business Practice Location Address Fax Number:
715-623-4013
Provider Enumeration Date:
12/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ZINDA
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE
Authorized Official Telephone Number:
715-623-7887

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41487600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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