1164428496 NPI number — GINA LOUISE KONTZ M.A.

Table of content: GINA LOUISE KONTZ M.A. (NPI 1164428496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164428496 NPI number — GINA LOUISE KONTZ M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONTZ
Provider First Name:
GINA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A.
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:
1164428496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
590 SOUTH HWY 29, STE. 3
Provider Second Line Business Mailing Address:
PO BOX 205
Provider Business Mailing Address City Name:
MONTEVIDEO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-321-1551
Provider Business Mailing Address Fax Number:
320-321-1552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 SOUTH HWY 29, STE. 3
Provider Second Line Business Practice Location Address:
PO BOX 205
Provider Business Practice Location Address City Name:
MONTEVIDEO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-321-1551
Provider Business Practice Location Address Fax Number:
320-321-1552
Provider Enumeration Date:
06/22/2005

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: 237600000X , with the licence number:  6279 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 231H00000X , with the licence number: 6279 , 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: 4500108 . This is a "UNITED HEALTH CARE PROV #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5832630 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1024676 . This is a "PREFERRED ONE PROV. NUMBE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 45-00108 . This is a "MEDICA PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 031021002 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09339WI . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 39P72WI . This is a "GINA'S TESTING FOR BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 41-1603792001 . This is a "TRICARE WEST PROV. NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 568819100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117072 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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