1265177398 NPI number — BEMIDJI AREA PROGRAM FOR RECOVERY, INC.

Table of content: LOIS E. WISE MD (NPI 1669440921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265177398 NPI number — BEMIDJI AREA PROGRAM FOR RECOVERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEMIDJI AREA PROGRAM FOR RECOVERY, 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'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:
1265177398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 4TH ST NW STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEMIDJI
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56601-3196
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-444-5155
Provider Business Mailing Address Fax Number:
218-333-3921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16730 US HWY 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAGLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-444-5155
Provider Business Practice Location Address Fax Number:
218-333-3921
Provider Enumeration Date:
05/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BUSCHER
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
218-444-5155

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1411674742 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1363897080 . This is a "BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1410984460 . This is a "BLUE CROSS BLUE SHIELD MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1411901281 . This is a "PRIMEWEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1363573805 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".




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