1215149364 NPI number — JOHN M ENGER, PROFESSIONAL ASSOCIATION

Table of content: (NPI 1215149364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215149364 NPI number — JOHN M ENGER, PROFESSIONAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN M ENGER, PROFESSIONAL ASSOCIATION
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:
COMMUNITY FOOT CLINIC
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 Information

NPI Number:
1215149364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
904 E PLAZA STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBERT LEA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-373-6133
Provider Business Mailing Address Fax Number:
507-373-0261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
904 E PLAZA STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBERT LEA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-373-6133
Provider Business Practice Location Address Fax Number:
507-373-0261
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KLATT
Authorized Official First Name:
TRAVIS
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
507-373-6133

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 803725600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0491043 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 236266000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0953471 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480027955 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: CS1038 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: P00309735 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 213825500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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