1417188376 NPI number — BETTE MAGYAR JOHNSON CONSULTING, INC.

Table of content: (NPI 1417188376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417188376 NPI number — BETTE MAGYAR JOHNSON CONSULTING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETTE MAGYAR JOHNSON CONSULTING, INC.
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:
1417188376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 BARRY AVE S
Provider Second Line Business Mailing Address:
#321
Provider Business Mailing Address City Name:
WAYZATA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55391-1655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-404-2610
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 OAK STREET
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-871-8684
Provider Business Practice Location Address Fax Number:
612-871-2374
Provider Enumeration Date:
07/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
BETTE
Authorized Official Middle Name:
MAGYAR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
952-404-2610

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  LP2862 , 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: 525850200 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 62093JO . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 113885 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6145828 . This is a "MEDICA-UBH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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