1366430225 NPI number — MR. QUINN PHILIP STEIN M.S., C.G.C.

Table of content: MR. QUINN PHILIP STEIN M.S., C.G.C. (NPI 1366430225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366430225 NPI number — MR. QUINN PHILIP STEIN M.S., C.G.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEIN
Provider First Name:
QUINN
Provider Middle Name:
PHILIP
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S., C.G.C.
Provider Gender Code:
M

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:
1366430225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 W 22ND ST
Provider Second Line Business Mailing Address:
MB3
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57105-7702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-328-4640
Provider Business Mailing Address Fax Number:
605-328-4601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 W 22ND ST
Provider Second Line Business Practice Location Address:
MB3
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57105-7702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-328-4640
Provider Business Practice Location Address Fax Number:
605-328-4601
Provider Enumeration Date:
10/13/2005

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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