1346624384 NPI number — TRIA ORTHOPAEDIC CENTER LLC

Table of content: (NPI 1346624384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346624384 NPI number — TRIA ORTHOPAEDIC CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRIA ORTHOPAEDIC CENTER LLC
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:
TRIA CLINIC EPISODIC BUNDLE
Provider Other Organization Name Type Code:
5
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:
1346624384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8100 NORTHLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55431-4800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-831-8742
Provider Business Mailing Address Fax Number:
952-831-1626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8100 NORTHLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55431-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-831-8742
Provider Business Practice Location Address Fax Number:
952-831-1626
Provider Enumeration Date:
07/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LUHRS
Authorized Official First Name:
JASON
Authorized Official Middle Name:
J
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
952-883-7158

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2471M1202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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