1750372900 NPI number — HANI SHABAN ALKHATIB MB, BCH

Table of content: HANI SHABAN ALKHATIB MB, BCH (NPI 1750372900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750372900 NPI number — HANI SHABAN ALKHATIB MB, BCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALKHATIB
Provider First Name:
HANI
Provider Middle Name:
SHABAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MB, BCH
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:
1750372900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 CENTRACARE CIR, #1600
Provider Second Line Business Mailing Address:
CENTRACARE CLINIC HEALTH PLAZA SPECIALTY/ONCOLOGY
Provider Business Mailing Address City Name:
ST CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-229-4907
Provider Business Mailing Address Fax Number:
320-229-5160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 CENTRACARE CIR, #1600
Provider Second Line Business Practice Location Address:
CENTRACARE CLINIC HEALTH PLAZA SPECIALTY/ONCOLOGY
Provider Business Practice Location Address City Name:
ST CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-229-4907
Provider Business Practice Location Address Fax Number:
320-229-5160
Provider Enumeration Date:
11/04/2005

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: 207RH0003X , with the licence number:  34615 , 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: 900000917 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1001406 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 499R1KH . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 009517600 . This is a "MEDICAL ASSISTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3600190 . This is a "MEDICA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 009517600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05T20AL . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2129263 . This is a "FIRST HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP27008 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 830000282 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112085 . This is a "U CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20111 . This is a "ARAZ GRP AMERICA'S PPO" identifier . This identifiers is of the category "OTHER".




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