1679664254 NPI number — WOLFRAM ASSOCIATES, LTD.

Table of content: (NPI 1679664254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679664254 NPI number — WOLFRAM ASSOCIATES, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOLFRAM ASSOCIATES, LTD.
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:
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:
1679664254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5709 MEADOWLARK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56303-0737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-420-1146
Provider Business Mailing Address Fax Number:
320-258-4380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 1ST ST N
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
SAINT CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303-4256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-420-1146
Provider Business Practice Location Address Fax Number:
320-258-4380
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOLFRAM
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
320-420-1146

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  LP3758 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: LP3758 , 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: 6102104 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1014973 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101219 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 71Q68WO . This is a "BLUECROSS BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 71Q69WO . This is a "BLUECROSS BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 174708800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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