1831315191 NPI number — ALLIED MENTAL HEALTH SPECIALTY GROUP SC

Table of content: (NPI 1831315191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831315191 NPI number — ALLIED MENTAL HEALTH SPECIALTY GROUP SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIED MENTAL HEALTH SPECIALTY GROUP SC
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:
Provider Other Organization Name Type Code:
6
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:
1831315191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1334 HOSFORD ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54016-9230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-808-0795
Provider Business Mailing Address Fax Number:
715-808-0361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1334 HOSFORD ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54016-9230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-808-0795
Provider Business Practice Location Address Fax Number:
715-808-0361
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEVINS
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
715-808-0795

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1436-057 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 276P4BR . This is a "GROUP NUMBER BCBS BNEVINS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 374826056003 . This is a "BCBS ANEVINS PIN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1710043070 . This is a "NPI INDIVIDUAL ANEVINS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1982771317 . This is a "NPI IND NUM ANGELA SILER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 39172147012 . This is a "BCBS GROUP NUMBER BEVINS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 471547731E03 . This is a "BCBS PIN BNEVINS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 277P4NE . This is a "BCBS IND PROV NUM BNEVINS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 39087700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61-57474 . This is a "UBH BRAD NEVINS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 87G89NE . This is a "BCBS AUDREY NEVINS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 96G67SI . This is a "BCBS IND NUM A SILER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 936451035211 . This is a "PREFERREDONE ANEVINS PIN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 165875100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62-70147 . This is a "UBH AUDREYNEVINS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 39692000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110795 . This is a "BNEVINS HEALTHPARTNERS GR" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 87G99BR . This is a "GROUP NUM A NEVINS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 96G77BR . This is a "GROUP NUM ASILER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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