1639160898 NPI number — PAUL E. VANGORP M.D.

Table of content: CARLOS ALVAREZ MA (NPI 1043335144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639160898 NPI number — PAUL E. VANGORP M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANGORP
Provider First Name:
PAUL
Provider Middle Name:
E.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VANGORP
Provider Other First Name:
PAUL
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639160898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 9TH ST SE
Provider Second Line Business Mailing Address:
CENTRACARE HEALTH SYSTEM LONG PRAIRIE
Provider Business Mailing Address City Name:
LONG PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56347-1404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-732-2131
Provider Business Mailing Address Fax Number:
320-732-6913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 9TH ST SE
Provider Second Line Business Practice Location Address:
CENTRACARE HEALTH SYSTEM LONG PRAIRIE
Provider Business Practice Location Address City Name:
LONG PRAIRIE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56347-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-732-2131
Provider Business Practice Location Address Fax Number:
320-732-6913
Provider Enumeration Date:
11/04/2005

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: 207Q00000X , with the licence number:  21819 , 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: COMP . This is a "MMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: COMP . This is a "ONE HEALTH PLAN/GREATWEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP23039 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1006861 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116872 . This is a "U-CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0106463 . This is a "MEDICA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 499762000 . This is a "MEDICAL ASSISTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54Q37VA . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 784038 . This is a "FIRST HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 806968 . This is a "ARAZ GROUP/AMERICAS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: COMP . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".




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