1710083563 NPI number — BRUCE E SEMANS MD

Table of content: BRUCE E SEMANS MD (NPI 1710083563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710083563 NPI number — BRUCE E SEMANS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEMANS
Provider First Name:
BRUCE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1710083563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62563-9507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-498-5949
Provider Business Mailing Address Fax Number:
217-498-5950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62563-9507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-498-5949
Provider Business Practice Location Address Fax Number:
217-498-5950
Provider Enumeration Date:
09/16/2006

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: 291U00000X , with the licence number:  036-099321 , 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: 0008426749 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 070016016 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 806979200 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 399465 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7001271 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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