1508852823 NPI number — GIDGET L MCAREAVEY OTR

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508852823 NPI number — GIDGET L MCAREAVEY OTR

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MCAREAVEY

Provider First Name:

GIDGET

Provider Middle Name:

L

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

OTR

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

BUCK

Provider Other First Name:

GIDGET

Provider Other Middle Name:

L

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

1

NPI Number:

1508852823

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1720 S CLIFF AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SIOUX FALLS

Provider Business Mailing Address State Name:

SD

Provider Business Mailing Address Postal Code:

57105-2129

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

605-334-5630

Provider Business Mailing Address Fax Number:

605-332-5327

Provider First Line Business Practice Location Address:

1720 S CLIFF AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SIOUX FALLS

Provider Business Practice Location Address State Name:

SD

Provider Business Practice Location Address Postal Code:

57105-2129

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

605-334-5630

Provider Business Practice Location Address Fax Number:

605-332-5327

Provider Enumeration Date:

09/22/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225X00000X , with the licence number:  102491 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225X00000X , with the licence number: 0505 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 225X00000X , with the licence number: 01509 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 33486 . This is a "SIOUX VALLEY HEALTH PLANS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 5833760 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 64-03804 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 1782309 . This is a "ARAZ" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 4997012 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 64-03805 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 64-04052 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 308T9MC . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 4994828 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 5833762 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 5833763 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 64-05332 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 4996127 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 4996439 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 5833765 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".