1356639058 NPI number — LIFEVIEW CARE,PLLC

Table of content: (NPI 1356639058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356639058 NPI number — LIFEVIEW CARE,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEVIEW CARE,PLLC
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:
1356639058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 AMERICAN BLVD W
Provider Second Line Business Mailing Address:
SUITE 225
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55431-1079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-500-3337
Provider Business Mailing Address Fax Number:
855-715-1907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 AMERICAN BLVD W
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55431-1079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-500-3337
Provider Business Practice Location Address Fax Number:
855-715-1907
Provider Enumeration Date:
07/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HARMAN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
952-426-6427

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  1809 , 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: 1609853530 . This is a "PROVIDER NPI" identifier . This identifiers is of the category "OTHER".




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