1730205113 NPI number — NORTH UROLOGY, LTD.

Table of content: (NPI 1730205113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730205113 NPI number — NORTH UROLOGY, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH UROLOGY, LTD.
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:
1730205113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4080 W BROADWAY AVE
Provider Second Line Business Mailing Address:
SUITE #310
Provider Business Mailing Address City Name:
ROBBINSDALE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55422-5604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-520-5888
Provider Business Mailing Address Fax Number:
763-520-5955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4080 W BROADWAY AVE
Provider Second Line Business Practice Location Address:
SUITE #310
Provider Business Practice Location Address City Name:
ROBBINSDALE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55422-5604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-520-5888
Provider Business Practice Location Address Fax Number:
763-520-5955
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HACKETT
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
763-520-5888

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  040181 , 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: 32722000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18063TW . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 248645800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 339 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CP8671 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0001 . This is a "MEDICA CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001 . This is a "MEDICA PRIMARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101378 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".




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