1558455386 NPI number — ANDREW H RIKKERS DO

Table of content: ANDREW H RIKKERS DO (NPI 1558455386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558455386 NPI number — ANDREW H RIKKERS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIKKERS
Provider First Name:
ANDREW
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1558455386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2758
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERLOO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50704-2758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-235-5390
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1753 W RIDGEWAY AVE STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50701-4588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-833-5907
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006

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: 208600000X , with the licence number:  48190 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: DO-05746 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 390808509 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43524200 . This is a "HIRSP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14028 . This is a "DEAN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2014477 . This is a "PHYSICIANS PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43524200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390808509DR . This is a "UNITY" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com