1184681108 NPI number — DR. PAUL C ECKRICH MD

Table of content: (NPI 1437196300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184681108 NPI number — DR. PAUL C ECKRICH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ECKRICH
Provider First Name:
PAUL
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1184681108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1460
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57402-1460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-225-7326
Provider Business Mailing Address Fax Number:
605-229-2774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S LLOYD ST
Provider Second Line Business Practice Location Address:
SUITE E105
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57401-4552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-225-7326
Provider Business Practice Location Address Fax Number:
605-229-2774
Provider Enumeration Date:
04/26/2006

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: 208800000X , with the licence number:  3515 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208800000X , with the licence number: 6821 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0006854 . This is a "WELLMARK BCBS OF SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 7500243 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17721 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 779513100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3515 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 13029 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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