1881767069 NPI number — SPECTRUM COMMUNITY HEALTH, INC.

Table of content: (NPI 1881767069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881767069 NPI number — SPECTRUM COMMUNITY HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECTRUM COMMUNITY HEALTH, INC.
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:
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:
1881767069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 SIEGEL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVELETH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55734-8642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-741-3013
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 SIEGEL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVELETH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55734-8642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-741-3013
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HANSON
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE-PRESIDENT OF OPERATIONS, RN
Authorized Official Telephone Number:
651-451-0569

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  334658 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 310400000X , with the licence number: 313695 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 751355100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109875 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 109875 . This is a "UCARE OR SOUTH COUNTRY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 151101 . This is a "PRIME WEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 120015 . This is a "FIRST PLAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5900097 . This is a "MEDICA - GRAND RAPIDS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5900098 . This is a "MEDICA - WILLMAR" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5900101 . This is a "MEDICA - EVELETH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1023413 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5900095 . This is a "MEDICA - DULUTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8X73SP . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5900099 . This is a "MEDICA - ROCHESTER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5900100 . This is a "MEDICA - MINNEAPOLIS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5900096 . This is a "MEDICA - FAIRIBAULT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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