1821044884 NPI number — LIEM SOM OEI MD PC

Table of content: (NPI 1821044884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821044884 NPI number — LIEM SOM OEI MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIEM SOM OEI MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RENAL ASSOCIATES PC
Provider Other Organization Name Type Code:
3
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:
1821044884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
357 W TOWER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAKOTA DUNES
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57049-5018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-255-7746
Provider Business Mailing Address Fax Number:
712-255-0829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
357 W TOWER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAKOTA DUNES
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57049-5018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-255-7746
Provider Business Practice Location Address Fax Number:
712-255-0829
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
TERI
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
712-255-7746

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 098555 . This is a "NEBRASKA MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: S108150 . This is a "SOUTH DAKOTA PTAN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 02895 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0028951 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CI7806 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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