1538160551 NPI number — SARAH HINTZ BOLCER D.P.M.

Table of content: SARAH HINTZ BOLCER D.P.M. (NPI 1538160551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538160551 NPI number — SARAH HINTZ BOLCER D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOLCER
Provider First Name:
SARAH
Provider Middle Name:
HINTZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1538160551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19230 EVANS ST NW
Provider Second Line Business Mailing Address:
STE 109
Provider Business Mailing Address City Name:
ELK RIVER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55330-1079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-441-6220
Provider Business Mailing Address Fax Number:
763-441-2207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19230 EVANS ST NW
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
ELK RIVER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55330-1079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-441-6220
Provider Business Practice Location Address Fax Number:
763-441-2207
Provider Enumeration Date:
08/02/2005

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: 213E00000X , with the licence number:  614 , 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: 737612000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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