1407992373 NPI number — MY SKIN CLINICS PLC

Table of content: (NPI 1407992373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407992373 NPI number — MY SKIN CLINICS PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MY SKIN CLINICS PLC
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:
REBE SKIN AND VEIN CLINIC
Provider Other Organization Name Type Code:
3
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:
1407992373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKOBOJI
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51355-0125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-332-6001
Provider Business Mailing Address Fax Number:
712-332-6010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 HIGHWAY 71 UNIT 1&4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPIRIT LAKE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51360-7634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-332-6001
Provider Business Practice Location Address Fax Number:
712-332-6010
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOLEGRAFF
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER AND PROVIDER
Authorized Official Telephone Number:
712-332-6001

Provider Taxonomy Codes

  • Taxonomy code: 202K00000X , with the licence number:  24582 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 24582 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DO5034 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0746875 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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