1316059660 NPI number — ANDREW G MAYO M.D.

Table of content: ANDREW G MAYO M.D. (NPI 1316059660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316059660 NPI number — ANDREW G MAYO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAYO
Provider First Name:
ANDREW
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1316059660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7755 3RD ST N STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKDALE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55128-5461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-497-6101
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1065 N 115TH ST STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68154-4423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-609-4818
Provider Business Practice Location Address Fax Number:
402-502-4567
Provider Enumeration Date:
08/31/2006

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: 207Q00000X , with the licence number:  38746 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080114800 . This is a "RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64Q34MA . This is a "BLUE CROSS MN PRO FEE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 27G42MA . This is a "BLUE CROSS MN FACILITY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 692222800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0102524 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1014043 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: NA9031014043 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP18067 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com