1841246428 NPI number — CARRIE A TOBKIN PT

Table of content: CARRIE A TOBKIN PT (NPI 1841246428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841246428 NPI number — CARRIE A TOBKIN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOBKIN
Provider First Name:
CARRIE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROSSART
Provider Other First Name:
CARRIE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841246428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 727
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT LAKES
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56502-0727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-844-2300
Provider Business Mailing Address Fax Number:
218-844-2444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 FRAZEE ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT LAKES
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56501-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-844-2300
Provider Business Practice Location Address Fax Number:
218-844-2444
Provider Enumeration Date:
05/26/2006

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: 225100000X , with the licence number:  6200 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 37736 . This is a "LHS/BANNERHEALTH #" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
  • Identifier: 6405176 . This is a "MEDICA #" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
  • Identifier: 908S3TO . This is a "MNBS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 54906 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1070686 . This is a "AMERICA'S PPO/ARAZ #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 24979 . This is a "NDBS #" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
  • Identifier: HP28535 . This is a "HEALTHPARTNERS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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