1942380613 NPI number — ADVANCED HEALTH PA

Table of content: (NPI 1942380613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942380613 NPI number — ADVANCED HEALTH PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED HEALTH PA
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:
1942380613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6280 HWY 65
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRIDLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-571-9499
Provider Business Mailing Address Fax Number:
763-502-0364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6280 HWY 65
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRIDLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-571-9499
Provider Business Practice Location Address Fax Number:
763-502-0364
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEBEISEN
Authorized Official First Name:
GREG
Authorized Official Middle Name:
CURTIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
763-571-9499

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 665950 . This is a "AMERICAS PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 665950 . This is a "DEFINITY HEALTH" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 230321 . This is a "CHIROCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 47676807801 . This is a "CIGNA HELATH CARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 230321 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 767527500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01005230 . This is a "PREFERED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1026232 . This is a "PAS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 231414 . This is a "AMERICAN SPECIALTY HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 4448225 . This is a "MEDICA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 237P3HE . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4425650 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: CC00773 . This is a "CHIROCARE OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 377 . This is a "HEALTH SERVICE MGMT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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