1679599864 NPI number — HAROLD J HERBST PA-C

Table of content: HAROLD J HERBST PA-C (NPI 1679599864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679599864 NPI number — HAROLD J HERBST PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERBST
Provider First Name:
HAROLD
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

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:
1679599864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 746
Provider Second Line Business Mailing Address:
1412 MAIN STREET
Provider Business Mailing Address City Name:
HAWLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56549-0746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-483-3564
Provider Business Mailing Address Fax Number:
218-483-3567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1412 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAWLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-483-3564
Provider Business Practice Location Address Fax Number:
218-483-3567
Provider Enumeration Date:
07/14/2006

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: 363AM0700X , with the licence number:  9077 , 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: 1001271 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20642 . This is a "SIOUX VALLEY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61A01HE . This is a "MN BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 71103 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP25754 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23576 . This is a "ND BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0111645 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 701826600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 970003849 . This is a "ND RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 970003854 . This is a "MN RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 944702 . This is a "AMERICAS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: N4664 . This is a "ND MEDICARE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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