1679570576 NPI number — DR. ANGELA J. ALDRICH M.D.

Table of content: EILEEN F BOROWSKI PHD (NPI 1265505101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679570576 NPI number — DR. ANGELA J. ALDRICH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALDRICH
Provider First Name:
ANGELA
Provider Middle Name:
J.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1679570576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2730 PIERCE ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51104-3764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-277-3141
Provider Business Mailing Address Fax Number:
712-277-2645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2730 PIERCE ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51104-3796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-277-3141
Provider Business Practice Location Address Fax Number:
712-277-2645
Provider Enumeration Date:
07/07/2005

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: 207V00000X , with the licence number:  4578 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 33041 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00064861 . This is a "MEDICARE PTAN RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: IB2715002 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1679570576 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679570576 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679570576 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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