1073585592 NPI number — ADRIENNE E FRICKER-ELHAI PH.D.

Table of content: ADRIENNE E FRICKER-ELHAI PH.D. (NPI 1073585592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073585592 NPI number — ADRIENNE E FRICKER-ELHAI PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRICKER-ELHAI
Provider First Name:
ADRIENNE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1073585592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2150 W CENTRAL AVE FL 2
Provider Second Line Business Mailing Address:
PROMEDICA TCH CULLEN CENTER, CHS BLDG
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43606-3834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-291-7919
Provider Business Mailing Address Fax Number:
419-479-3273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2150 W CENTRAL AVE FL 2
Provider Second Line Business Practice Location Address:
PROMEDICA TCH CULLEN CENTER, CHS BLDG
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43606-3834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-291-7919
Provider Business Practice Location Address Fax Number:
419-479-3273
Provider Enumeration Date:
02/07/2006

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: 103TC2200X , with the licence number:  6575 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12200 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 238934 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: HP37521 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: P00013287 . This is a "RR MEDICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 1766590 . This is a "ARAZ/ AMERICA'S PPO" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 46022474352 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4996337 . This is a "BLUE CROSS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 57108C024 . This is a "WPS TRICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 040121002 . This is a "PRIMEWEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3989442 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 412991032870 . This is a "PREFERRED ONE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6551990 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 044G1EL . This is a "CC SYSTEMS/ BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 28317 . This is a "SANFORD HEALTH PLAN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 441 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 370624200 . This is a "DEPT OF LABOR" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 483958700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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