1376585059 NPI number — KURT W POSSAI DO

Table of content: KURT W POSSAI DO (NPI 1376585059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376585059 NPI number — KURT W POSSAI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POSSAI
Provider First Name:
KURT
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1376585059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 SANFORD PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THIEF RIVER FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56701-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-683-2725
Provider Business Mailing Address Fax Number:
218-683-2725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 SANFORD PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THIEF RIVER FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56701-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-681-4747
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2006

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: 207X00000X , with the licence number:  43229 , 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: 0900330 . This is a "MEDICA #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 142048 . This is a "UCARE #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 19484 . This is a "NDBS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 92D03PO . This is a "MNBS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 98D09PO . This is a "MNBS #" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
  • Identifier: 1154017 . This is a "AMERICA'S PPO/ARAZ #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 11858 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: MN200034 . This is a "LHS/BANNERHEALTH #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0900335 . This is a "MEDICA #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 901452700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA9021026992 . This is a "PREFERRED ONE #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: DA9071026992 . This is a "PREFERRED ONE #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP38401 . This is a "HEALTHPARTNERS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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