1144219213 NPI number — DR. JOHN ALLEN CONROY OD

Table of content: ABIGAIL ELIZABETH ANZALONE (NPI 1013386127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144219213 NPI number — DR. JOHN ALLEN CONROY OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONROY
Provider First Name:
JOHN
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1144219213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILBANK
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57252-2424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-432-5730
Provider Business Mailing Address Fax Number:
605-432-4324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILBANK
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57252-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-432-5730
Provider Business Practice Location Address Fax Number:
605-432-4324
Provider Enumeration Date:
10/20/2005

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: 152W00000X , with the licence number:  SD491 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 2118 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 358723100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4645120001 . This is a "DMERC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4645120002 . This is a "DMERC" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 9202533 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com