1659503233 NPI number — SHINAMERICA

Table of content: (NPI 1659503233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659503233 NPI number — SHINAMERICA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHINAMERICA
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:
ULTI MED
Provider Other Organization Name Type Code:
3
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:
1659503233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 476
Provider Second Line Business Mailing Address:
710 4TH STREET
Provider Business Mailing Address City Name:
DE SMET
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-854-3434
Provider Business Mailing Address Fax Number:
605-854-9234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 4TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DE SMET
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-854-3434
Provider Business Practice Location Address Fax Number:
605-854-9234
Provider Enumeration Date:
08/17/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ERICKSON
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
651-291-7909

Provider Taxonomy Codes

  • Taxonomy code: 332BD1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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