1033275748 NPI number — MASON MOORE CONSULTANTS

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 1033275748 NPI number — MASON MOORE CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASON MOORE CONSULTANTS
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:
1033275748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5009 EXCELSIOR BLVD STE 136
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416-3049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-925-5343
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5009 EXCELSIOR BLVD STE 136
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416-3049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-925-5343
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
ALLISON
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
952-925-5343

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  LP2399 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11934MO . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6109358 . This is a "MEDICA ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com