1164557799 NPI number — BIOFEEDBACK TRAINING AND TREATMENT CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164557799 NPI number — BIOFEEDBACK TRAINING AND TREATMENT CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIOFEEDBACK TRAINING AND TREATMENT CENTER, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1164557799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5001 AMERICAN BLVD W STE 980
Provider Second Line Business Mailing Address:
BIOFEEDBACK TRAINING & TREATMENT CENTER, INC.
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55437-1164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-893-9400
Provider Business Mailing Address Fax Number:
952-698-3532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5001 AMERICAN BLVD W STE 980
Provider Second Line Business Practice Location Address:
BIOFEEDBACK TRAINING & TREATMENT CENTER, INC.
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55437-1164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-893-9400
Provider Business Practice Location Address Fax Number:
952-698-3532
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JEFFREY-SMITH
Authorized Official First Name:
LILLI
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CENTER DIRECTOR
Authorized Official Telephone Number:
952-893-9400

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01458BI . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 623080001 . This is a "CIGNA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 04004001 . This is a "METROPOLITAN HEALTH PLAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3948 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01-23460 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 31800 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7963785-00 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9657479-00 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00014 . This is a "SELECT CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4544126 . This is a "AETNA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 109585 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3D4274BE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 49-80023 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 88G75HA . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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