1366488587 NPI number — MR. ERIC SAGE SALMAN P.A.C

Table of content: (NPI 1215403340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366488587 NPI number — MR. ERIC SAGE SALMAN P.A.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALMAN
Provider First Name:
ERIC
Provider Middle Name:
SAGE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.A.C
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:
1366488587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1950 NORTHWESTERN AVE S
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
STILLWATER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55082-7615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-430-3800
Provider Business Mailing Address Fax Number:
651-241-7272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1835 COUNTY ROAD C W STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55113-1343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-430-3800
Provider Business Practice Location Address Fax Number:
651-430-3827
Provider Enumeration Date:
06/22/2006

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: 363A00000X , with the licence number:  00062701 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 00062924 , 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: 970000766 . This is a "RR MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1022092 . This is a "AMERICAS PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 42994400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP30663 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 801634800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129779 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 56B10SA . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0119751 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1023774 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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