1699778829 NPI number — CHIPPEWA VALLEY ORTHOPEDICS AND SPORTS MEDICINE CLINIC SC

Table of content: (NPI 1699778829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699778829 NPI number — CHIPPEWA VALLEY ORTHOPEDICS AND SPORTS MEDICINE CLINIC SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIPPEWA VALLEY ORTHOPEDICS AND SPORTS MEDICINE CLINIC SC
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:
1699778829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 OAKLEAF WAY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
ALTOONA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54720-2245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-832-1400
Provider Business Mailing Address Fax Number:
715-832-4187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 OAKLEAF WAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54720-2245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-832-1400
Provider Business Practice Location Address Fax Number:
715-832-4187
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CROW
Authorized Official First Name:
AUSTIN
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
715-832-1400

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0014X , with the licence number: 54216 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100249466 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21278700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220399400 . This is a "OWCP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 2416091 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 542R9CH . This is a "BCBS OF MN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 41741700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com