1356321467 NPI number — JEFFERY J TEMPLE NP

Table of content: JEFFERY J TEMPLE NP (NPI 1356321467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356321467 NPI number — JEFFERY J TEMPLE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEMPLE
Provider First Name:
JEFFERY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1356321467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 GOLF COURSE RD
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55744-3526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-326-8749
Provider Business Mailing Address Fax Number:
218-326-0400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 GOLF COURSE RD
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55744-3526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-326-8749
Provider Business Practice Location Address Fax Number:
218-326-0400
Provider Enumeration Date:
01/17/2006

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: 363LP2300X , with the licence number:  0359861 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HP49668 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 849650100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 982221028303 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 143435 . This is a "U CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: NO10804 . This is a "CHAMPUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 849650100 . This is a "ITASCA MEDICAL CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0106837 . This is a "MEIDCA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 41B60TE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 500026265 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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