1679572440 NPI number — MR. JOHN A GESS OD

Table of content: MR. JOHN A GESS OD (NPI 1679572440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679572440 NPI number — MR. JOHN A GESS OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GESS
Provider First Name:
JOHN
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1679572440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 15TH AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56308-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-762-5112
Provider Business Mailing Address Fax Number:
320-763-3297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 15TH AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56308-2512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-762-5112
Provider Business Practice Location Address Fax Number:
320-763-3297
Provider Enumeration Date:
07/14/2005

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: 152W00000X , with the licence number:  1921 , 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: HP34132/80031 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 48G31GE . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: T65538 . This is a "HUMANA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 030701146 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: T65538 . This is a "UNICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 22-00883 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 077023000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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