1750486528 NPI number — DAVID H KLAPPERICH CRNA

Table of content: DAVID H KLAPPERICH CRNA (NPI 1750486528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750486528 NPI number — DAVID H KLAPPERICH CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLAPPERICH
Provider First Name:
DAVID
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1750486528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 E 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACONIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55387-4552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-442-9770
Provider Business Mailing Address Fax Number:
952-442-3620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2215 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-775-8861
Provider Business Practice Location Address Fax Number:
952-442-3620
Provider Enumeration Date:
09/14/2006

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: 367500000X , with the licence number:  209007845 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: R078249-6 , 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: 539S1KL . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP57497 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 171256 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2001729 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 967551010905 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 927742100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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