1932261377 NPI number — POWER OF RELATIONSHIPS

Table of content: (NPI 1932261377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932261377 NPI number — POWER OF RELATIONSHIPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POWER OF RELATIONSHIPS
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:
1932261377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14329 ALLEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVAGE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55378-2230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-221-2441
Provider Business Mailing Address Fax Number:
612-874-6745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 LILAC DR N
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
GOLDEN VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55422-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-874-6746
Provider Business Practice Location Address Fax Number:
612-874-6745
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KEENAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT, EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
612-221-2441

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  LP3544 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , with the licence number: LP3544 , 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: 136564 . This is a "UCARE-MN IND NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 446316100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 446316101 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84-63537 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 136560 . This is a "UCARE-MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 26A03PO . This is a "BLUE CROSS GROUP NMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 990223002 . This is a "MHP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 45291 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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