1487706735 NPI number — MCBE COMPANY

Table of content: (NPI 1487706735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487706735 NPI number — MCBE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCBE COMPANY
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:
WEBER & JUDD - CHATFIELD
Provider Other Organization Name Type Code:
3
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:
1487706735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5877
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55903-5877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
237 MAIN ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATFIELD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55923-1170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-867-4425
Provider Business Practice Location Address Fax Number:
507-867-4451
Provider Enumeration Date:
01/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HANSON
Authorized Official First Name:
WADE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
507-289-1666

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 261740 , 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: 1487706735 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 959622400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2423755 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".