1689635898 NPI number — MRS. MICHAL C JORGENS LP

Table of content: MRS. MICHAL C JORGENS LP (NPI 1689635898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689635898 NPI number — MRS. MICHAL C JORGENS LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORGENS
Provider First Name:
MICHAL
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KULEN KAMP
Provider Other First Name:
M
Provider Other Middle Name:
C
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:
1689635898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603 BRUCE ST
Provider Second Line Business Mailing Address:
PO BOX 603
Provider Business Mailing Address City Name:
CROOKSTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56716-0603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-281-3940
Provider Business Mailing Address Fax Number:
218-281-6261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 BRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROOKSTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56716-0603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-281-3940
Provider Business Practice Location Address Fax Number:
218-281-6261
Provider Enumeration Date:
03/29/2006

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: 103TC0700X , with the licence number:  LP4502 , 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: HP41099 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1040686 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 24335 . This is a "BCBS OF ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 140670 . This is a "UCARE MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 444T6J0 . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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