1508552696 NPI number — PRODUCTION FARM, INC.

Table of content: DR. ARIANA NICOLE EGINLI M.D. (NPI 1891220299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508552696 NPI number — PRODUCTION FARM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRODUCTION FARM, INC.
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:
1508552696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2668 STONEGATE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUAMICO
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54313-8123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-288-1965
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
621 BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHEBOYGAN FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53085-1544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-305-6313
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SEYMOUR
Authorized Official First Name:
JAY
Authorized Official Middle Name:
PATRICK MUSE
Authorized Official Title or Position:
CFO/MANAGING DIRECTOR
Authorized Official Telephone Number:
920-305-6313

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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