1093799603 NPI number — TIMOTHY BACHENBERG MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093799603 NPI number — TIMOTHY BACHENBERG MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BACHENBERG

Provider First Name:

TIMOTHY

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1093799603

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/19/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

800 MEDICAL CENTER DR

Provider Second Line Business Mailing Address:

PO BOX 800

Provider Business Mailing Address City Name:

FAIRMONT

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

56031-4575

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

507-238-8555

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

800 MEDICAL CENTER DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FAIRMONT

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

56031-4575

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

507-238-8555

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

12/06/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  34448 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 06Q36BA . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 7293 . This is a "AVERA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 23346 . This is a "SIOUX VALLEY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 604566 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP29866 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 01-13050 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 06Q36BA , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 120541 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 983395 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: MH9041001734 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 762580400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: A021 . This is a "CHAMPUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".