1851406151 NPI number — ELIM PREFERRED SERVICES INC.

Table of content: (NPI 1851406151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851406151 NPI number — ELIM PREFERRED SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIM PREFERRED SERVICES INC.
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:
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:
1851406151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2820 VICKSBURG LN N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55447-1878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-550-9486
Provider Business Mailing Address Fax Number:
763-550-1458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2820 VICKSBURG LN N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55447-1878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-550-9486
Provider Business Practice Location Address Fax Number:
763-550-1458
Provider Enumeration Date:
08/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LETICH
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
763-550-9486

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 75264EL . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 109527 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8200116 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8214411 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".