1790783041 NPI number — DR. NICHOLAS TODD RANSON M. D.

Table of content: DR. NICHOLAS TODD RANSON M. D. (NPI 1790783041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790783041 NPI number — DR. NICHOLAS TODD RANSON M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANSON
Provider First Name:
NICHOLAS
Provider Middle Name:
TODD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M. D.
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:
1790783041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
929 BUSINESS PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49686-8683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-594-7062
Provider Business Mailing Address Fax Number:
231-594-7886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
929 BUSINESS PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRAVERSE CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49686-8683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-947-6246
Provider Business Practice Location Address Fax Number:
231-947-8864
Provider Enumeration Date:
07/11/2005

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: 207W00000X , with the licence number:  2024004550 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0200X , with the licence number: MD00042059 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0200X , with the licence number: 2024004550 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: MD00042059 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 806847202 . This is a "PUBLIC ASSISTANCE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 0182076 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8384828 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: S 9296RA . This is a "ASURIS (REGENCE NW HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: WA 0690 . This is a "NORTHWEST BENEFIT NETWORK" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: KW906 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: P00108507 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: A034 . This is a "TRICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 000010147398 . This is a "ASURIS (REGENCE BS OF ID)" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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