1457387391 NPI number — MICHAEL R MYERS CRNA

Table of content: MICHAEL R MYERS CRNA (NPI 1457387391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457387391 NPI number — MICHAEL R MYERS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
MICHAEL
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1457387391
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14914 67TH ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAFTON
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58237-9206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-352-3604
Provider Business Mailing Address Fax Number:
701-352-3604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14914 67TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAFTON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58237-9206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-352-3604
Provider Business Practice Location Address Fax Number:
701-352-3604
Provider Enumeration Date:
06/23/2006

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: 367500000X , with the licence number:  R121975-1 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: R19657 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ND200189 . This is a "LHS/BANNERHEALTH #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 86D19MY . This is a "MNBS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 937254 . This is a "AMERICA'S PPO/ARAZ #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 952526200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: DAP021026986 . This is a "PREFERRED ONE #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP38638 . This is a "HEALTHPARTNERS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 169230 . This is a "UCARE #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 19063 . This is a "NDBS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2000780 . This is a "MEDICA #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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