1649233214 NPI number — JOHN MANUEL ARIAS MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649233214 NPI number — JOHN MANUEL ARIAS MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ARIAS

Provider First Name:

JOHN

Provider Middle Name:

MANUEL

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

ARIAS

Provider Other First Name:

JUAN

Provider Other Middle Name:

MANUEL

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

MD

Provider Other Last Name Type Code:

1

NPI Number:

1649233214

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/31/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

11995 SINGLETREE LN

Provider Second Line Business Mailing Address:

SUITE 500

Provider Business Mailing Address City Name:

EDEN PRAIRIE

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55344-5347

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

952-595-1100

Provider Business Mailing Address Fax Number:

952-942-3361

Provider First Line Business Practice Location Address:

9010 SADDLEBACK RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PARK CITY

Provider Business Practice Location Address State Name:

UT

Provider Business Practice Location Address Postal Code:

84098-4740

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

952-595-1100

Provider Business Practice Location Address Fax Number:

952-942-3361

Provider Enumeration Date:

04/06/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  M9472 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 182009-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 3810010512 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 000000548183 . This is a "ANTHEM-KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 2822897 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 7100025880 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: P00403946 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 3427946000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 2016383 . This is a "HIGHMARK BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 50017692 . This is a "PASSPORT-KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 91715 . This is a "SIHO-KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 102079853 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1649233214 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".