1679892707 NPI number — ASHLEE KAYE HOLST D.O.

Table of content: ASHLEE KAYE HOLST D.O. (NPI 1679892707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679892707 NPI number — ASHLEE KAYE HOLST D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLST
Provider First Name:
ASHLEE
Provider Middle Name:
KAYE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BALES
Provider Other First Name:
ASHLEE
Provider Other Middle Name:
KAYE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679892707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 JOHN DEERE RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-6812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-779-4200
Provider Business Mailing Address Fax Number:
309-779-4305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 JOHN DEERE RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-6812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-779-4200
Provider Business Practice Location Address Fax Number:
309-779-4305
Provider Enumeration Date:
05/28/2010

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: 207R00000X , with the licence number:  4410 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 036141459 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036141459 . This is a "BLUE SHIELD OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1679892707 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679892707 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036141459 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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