1811964794 NPI number — DR. HARLAN JAY VANDER GRIEND OD

Table of content: (NPI 1013032317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811964794 NPI number — DR. HARLAN JAY VANDER GRIEND OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDER GRIEND
Provider First Name:
HARLAN
Provider Middle Name:
JAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1811964794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
928 3RD AVENUE
Provider Second Line Business Mailing Address:
PO BOX 100
Provider Business Mailing Address City Name:
SHELDON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51201-0100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-324-2552
Provider Business Mailing Address Fax Number:
712-324-2553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
928 3RD AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELDON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51201-0100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-324-2552
Provider Business Practice Location Address Fax Number:
712-324-2553
Provider Enumeration Date:
03/01/2006

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: 152W00000X , with the licence number:  1668 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11753 . This is a "WELLMARK INDV PAULLINA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 33330 . This is a "WELLMARK GROUP SHELDON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: I7585 . This is a "MEDICARE GROUP PAULLINA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: CS7580 . This is a "RR MEDICARE GROUP SHELDON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0280586 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16177 . This is a "MEDICARE INDV SHELDON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0280578 . This is a "MEDICAID GROUP PAULLINA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0280586 . This is a "MEDICAID GROUP SHELDON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 11753 . This is a "MEDICARE INDV PAULLINA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 2161778 . This is a "MEDICAID INDV PAULLINA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: I7584 . This is a "MEDICARE GROUP SHELDON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 33340 . This is a "WELLMARK GROUP PAULLINA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: CE1831 . This is a "RR MEDICARE GROUP PAULLIN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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