1841289642 NPI number — DR. ANDREA JEANNE URBACH OD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841289642 NPI number — DR. ANDREA JEANNE URBACH OD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

URBACH

Provider First Name:

ANDREA

Provider Middle Name:

JEANNE

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

OD

Provider Gender Code:

F

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:

1841289642

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/13/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2925 CHICAGO AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MINNEAPOLIS

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55407-1321

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-262-9000

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1880 N FRONTAGE RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

HASTINGS

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55033-2687

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

651-438-1800

Provider Business Practice Location Address Fax Number:

651-438-1837

Provider Enumeration Date:

10/14/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  2834 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0725060001 . This is a "DMERC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 111314 . This is a "PATIENT CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 595809 . This is a "ARAZ/TPA/DEFINITY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2201698 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2201698 . This is a "SELECT CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 961571031014 . This is a "PREFERRED 1 COMM HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 230767606 . This is a "VSP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: N007 . This is a "TRICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 246J1UR . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1031014 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 132213 . This is a "UCARE FOR SENIORS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP35473 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".