1518131499 NPI number — NORTH METRO MIDWIVES, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518131499 NPI number — NORTH METRO MIDWIVES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH METRO MIDWIVES, P.A.
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:
1518131499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8301 GOLDEN VALLEY RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GOLDEN VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55427-4435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-520-2211
Provider Business Mailing Address Fax Number:
763-520-2222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8301 GOLDEN VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GOLDEN VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55427-4435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-520-2211
Provider Business Practice Location Address Fax Number:
763-520-2222
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SIMON
Authorized Official First Name:
KATHRINE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER AND PRESIDENT
Authorized Official Telephone Number:
763-520-2211

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  10970 , 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)

  • Identifier: 017097600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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