1184655813 NPI number — MINNESOTA LUNG CENTER LTD

Table of content: WHITNEY FENTRESS WEBBER DO (NPI 1588168744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184655813 NPI number — MINNESOTA LUNG CENTER LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINNESOTA LUNG CENTER LTD
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:
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:
1184655813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 E 28TH ST
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55407-1139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-567-7400
Provider Business Mailing Address Fax Number:
952-567-7414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 E 28TH ST
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55407-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-567-7400
Provider Business Practice Location Address Fax Number:
952-567-7414
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAYER
Authorized Official First Name:
DEB
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MGR.
Authorized Official Telephone Number:
952-567-7400

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CP2438 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 410210000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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