1164424305 NPI number — DOUGLAS COUNTY HOSPITAL

Table of content: (NPI 1164424305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164424305 NPI number — DOUGLAS COUNTY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS COUNTY HOSPITAL
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:
ALOMERE HEALTH
Provider Other Organization Name Type Code:
3
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:
1164424305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 17TH AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56308-3703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-762-1511
Provider Business Mailing Address Fax Number:
320-762-6101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 17TH AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56308-3703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-762-1511
Provider Business Practice Location Address Fax Number:
320-762-6101
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VAAGENES
Authorized Official First Name:
CARL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
320-762-6021

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , 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: 300101 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 61128DO . This is a "BLUE CROSS BLUE SHIELD PHYS FEES" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2M580DO . This is a "BLUE CROSS BLUE SHIELD MHU" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 216114537 . This is a "PRIME WEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: N715449 . This is a "MEDICARE PTAN" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 1517HDO . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 60004DO . This is a "BLUE CROSS BLUE SHIELD CRNA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 036345600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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