1467502070 NPI number — CAREFOCUS CORPORATION

Table of content: (NPI 1467502070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467502070 NPI number — CAREFOCUS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREFOCUS CORPORATION
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:
1467502070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2429 UNIVERSITY AVENUE WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-925-5598
Provider Business Mailing Address Fax Number:
651-925-5599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2429 UNIVERSITY AVENUE WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-544-6223
Provider Business Practice Location Address Fax Number:
952-544-6271
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEAD
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF NURSING
Authorized Official Telephone Number:
651-925-5598

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  876405100 , 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: 3D30CA . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 000821001 . This is a "METRO POLITAN HEALTH PLAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 150333 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 876405100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5900207 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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