1023004199 NPI number — BETH M MICKE OT

Table of content: BETH M MICKE OT (NPI 1023004199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023004199 NPI number — BETH M MICKE OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICKE
Provider First Name:
BETH
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZARBOCK
Provider Other First Name:
BETH
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023004199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 W 26TH ST
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:
57105-2446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-782-2300
Provider Business Mailing Address Fax Number:
605-782-2301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 W 26TH 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:
57105-2446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-782-2300
Provider Business Practice Location Address Fax Number:
605-782-2301
Provider Enumeration Date:
09/23/2005

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: 225X00000X , with the licence number:  0464 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 31685 . This is a "SIOUX VALLEY HEALTH PLANS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4996085 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 64-04068 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 64-04070 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 101K4MI . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 64-05328 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5834110 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5834113 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4996086 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4996087 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 64-04069 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4994834 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5834112 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1907880 . This is a "ARAZ" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5834114 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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