1417043399 NPI number — PALMEN CENTER FOR PSYCHIATRY AND PSYCHOTHERAPY

Table of content: MR. RICHARD VINCENT VANDERNECK P.C. (NPI 1215924907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417043399 NPI number — PALMEN CENTER FOR PSYCHIATRY AND PSYCHOTHERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMEN CENTER FOR PSYCHIATRY AND PSYCHOTHERAPY
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:
1417043399
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7415
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-269-6992
Provider Business Mailing Address Fax Number:
507-282-1735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 2ND AVE SW
Provider Second Line Business Practice Location Address:
STE M114
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-269-6992
Provider Business Practice Location Address Fax Number:
507-282-1735
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PALMEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
507-269-6992

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  26450 , 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)





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