1194767129 NPI number — JOEL H SPRINGAN OD

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 1194767129 NPI number — JOEL H SPRINGAN OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPRINGAN
Provider First Name:
JOEL
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1194767129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1137 COLUMBIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISMARCK
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58504-6515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-355-4446
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3119 N 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58503-0664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-222-3937
Provider Business Practice Location Address Fax Number:
701-255-3493
Provider Enumeration Date:
06/12/2006

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: 152W00000X , with the licence number:  435 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 22-03333 . This is a "MEDICA - NORTH CLINIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 482596 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24734 . This is a "BCBS - NORTH CLINIC" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 870435 . This is a "NDVSI - MAIN CLINIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22-03334 . This is a "MEDICA - MAIN CLINIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22986 . This is a "SIOUX VALLEY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 488241044248 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60321 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 892876 . This is a "NDVSI - NORTH CLINIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9203090 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: ND0435 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410038213 . This is a "RAILROAD MEDICARE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17383 . This is a "BCBS - MAIN CLINIC" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 61503 . This is a "COAST TO COAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: ND200 . This is a "VISION BENEFIT OF AMERICA" identifier . This identifiers is of the category "OTHER".




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