1780699488 NPI number — MR. ROGER W MEINEN CRNA

Table of content: MR. ROGER W MEINEN CRNA (NPI 1780699488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780699488 NPI number — MR. ROGER W MEINEN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEINEN
Provider First Name:
ROGER
Provider Middle Name:
W
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1780699488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 WALNUT ST
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
YANKTON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57078-4361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-664-5050
Provider Business Mailing Address Fax Number:
605-664-5051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 FOX RUN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YANKTON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57078-5341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-664-5050
Provider Business Practice Location Address Fax Number:
605-664-5051
Provider Enumeration Date:
07/30/2006

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: 163W00000X , with the licence number:  R014067 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 021848 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 020584922 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35254 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4993763 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5750832 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9220266 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: P00435823 . This is a "RAILROAD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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