1700881844 NPI number — HOWARD C HARDEN CRNA

Table of content: HOWARD C HARDEN CRNA (NPI 1700881844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700881844 NPI number — HOWARD C HARDEN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDEN
Provider First Name:
HOWARD
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1700881844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 E 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACONIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55387-4552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-442-9770
Provider Business Mailing Address Fax Number:
952-442-3620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8403 BRYANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80031-3809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-426-4810
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2005

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: 367500000X , with the licence number:  RN-72629 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 430034472 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 06776 . This is a "BLUE CROSS OF CO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 112269000 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84138324500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07726292 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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