1174574032 NPI number — EMPI INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174574032 NPI number — EMPI INC

Employer Identification Number (EIN):

Provider Organization Name:

EMPI 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 Other Organization Name:

EMPI

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:

1174574032

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

04/14/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

599 CARDIGAN RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ST PAUL

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55126

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

651-415-9000

Provider Business Mailing Address Fax Number:

800-450-3593

Provider First Line Business Practice Location Address:

599 CARDIGAN RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SAINT PAUL

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55126-3965

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

651-415-9000

Provider Business Practice Location Address Fax Number:

800-450-3593

Provider Enumeration Date:

05/15/2006

Authorized Official Last Name:

WEBER

Authorized Official First Name:

JAMES

Authorized Official Middle Name:

Authorized Official Title or Position:

DIRECTOR OF FINANCE

Authorized Official Telephone Number:

651-415-7257

• Taxonomy code: 332B00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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• Identifier: 174350000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
• Identifier: 200475300A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
• Identifier: 1703011300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 5601349 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 874389843 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 59673 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".