1770538019 NPI number — DR. PAUL J OLSON MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770538019 NPI number — DR. PAUL J OLSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSON
Provider First Name:
PAUL
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1770538019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5009
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57117-5009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-977-5000
Provider Business Mailing Address Fax Number:
605-977-5377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4520 W 69TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57108-8148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-977-5000
Provider Business Practice Location Address Fax Number:
605-977-5377
Provider Enumeration Date:
05/24/2006

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: 207RC0001X , with the licence number:  3412 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 3412 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0967554 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 931451029042 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 98533OL . This is a "MN BCBS - PLAN 91057NO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 24682 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001548 . This is a "SD BCBS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 3412 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 169677 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53994 . This is a "IA BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 6002470 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 899007700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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