1780654079 NPI number — TIMOTHY A SOELTER P.A.-C

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780654079 NPI number — TIMOTHY A SOELTER P.A.-C

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SOELTER

Provider First Name:

TIMOTHY

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

P.A.-C

Provider Gender Code:

M

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:

1780654079

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/26/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

458 KINGS ROAD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FAIRMONT

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

56031-2116

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

507-236-5295

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

515 SOUTH MOORE STREET

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BLUE EARTH

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

56013

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

507-526-3273

Provider Business Practice Location Address Fax Number:

507-526-7724

Provider Enumeration Date:

01/26/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363A00000X , with the licence number:  9407 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 976445300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: HP30650 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 127863 . This is a "UCARE MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 388G2SO . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 8827 . This is a "AVERA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 29D91SO . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 974311024478 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 0113798 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 22906 . This is a "SANFORD HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 850268 . This is a "AMERICAS PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 970015283 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".