1568795623 NPI number — JED D HILLMER OD PLLC

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 1568795623 NPI number — JED D HILLMER OD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JED D HILLMER OD PLLC
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:
1568795623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 10TH ST N
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58102-4600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-239-9771
Provider Business Mailing Address Fax Number:
701-293-0944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 10TH ST N
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58102-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-239-9771
Provider Business Practice Location Address Fax Number:
701-293-0944
Provider Enumeration Date:
09/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HILLMER
Authorized Official First Name:
JED
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
701-239-9771

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  670 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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