1467440792 NPI number — MS. PATRICIA JANE BISCHOFF ARNP PAC

Table of content: MS. PATRICIA JANE BISCHOFF ARNP PAC (NPI 1467440792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467440792 NPI number — MS. PATRICIA JANE BISCHOFF ARNP PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BISCHOFF
Provider First Name:
PATRICIA
Provider Middle Name:
JANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP PAC
Provider Gender Code:
F

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:
1467440792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
621 S ILLINOIS AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MASON CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50401-5489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-428-3041
Provider Business Mailing Address Fax Number:
641-428-3059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 E TRAER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50636-7702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-816-4101
Provider Business Practice Location Address Fax Number:
641-428-8423
Provider Enumeration Date:
10/11/2005

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:  001096A , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: A084270 , 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: 0429753 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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