1730144080 NPI number — MS. ANNE MESICK LAMB PT, MSHCS

Table of content: MS. ANNE MESICK LAMB PT, MSHCS (NPI 1730144080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730144080 NPI number — MS. ANNE MESICK LAMB PT, MSHCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMB
Provider First Name:
ANNE
Provider Middle Name:
MESICK
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT, MSHCS
Provider Gender Code:
F

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:
1730144080
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1006 PRAIRIE LN NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWATONNA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55060-1977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-451-3860
Provider Business Mailing Address Fax Number:
507-451-3322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 W. BROADWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWATONNA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-451-7888
Provider Business Practice Location Address Fax Number:
507-451-3322
Provider Enumeration Date:
04/19/2006

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: 225100000X , with the licence number:  2283 , 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: 8B454LA . This is a "BCBS-MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP32089 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6400163 . This is a "MEDICA ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HEALTHPARTNERS . This is a "U CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1023448 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 069857100 . This is a "MINNESOTA HEALTH CARE PRO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 411853663 . This is a "TRICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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