1861488371 NPI number — LEE S GLASOE OTR/L, CHT

Table of content: LEE S GLASOE OTR/L, CHT (NPI 1861488371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861488371 NPI number — LEE S GLASOE OTR/L, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLASOE
Provider First Name:
LEE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, CHT
Provider Gender Code:
M

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:
1861488371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 S CLIFF AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57105-2129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-334-5630
Provider Business Mailing Address Fax Number:
605-332-5327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 S CLIFF AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57105-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-334-5630
Provider Business Practice Location Address Fax Number:
605-332-5327
Provider Enumeration Date:
09/21/2005

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: 225X00000X , with the licence number:  0063 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225X00000X , with the licence number: 100335 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225X00000X , with the licence number: 01344 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 5830435 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5830436 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14G13GL . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 20141 . This is a "SIOUX VALLEY HEALTH PLANS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 64-05326 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 9G906GL . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4994829 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 64-04223 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 24358 . This is a "ARAZ" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4996802 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 64-03863 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6434 . This is a "AVERA HEALTH PLANS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 64-07558 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4996129 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 64-01488 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4997070 . This is a "BLUE CROSS BLUE SHEILD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5830433 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64-01485 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 64-03581 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 64-04204 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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