1902899511 NPI number — PATRICK EDDIE FRANJE LISW

Table of content: PATRICK EDDIE FRANJE LISW (NPI 1902899511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902899511 NPI number — PATRICK EDDIE FRANJE LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRANJE
Provider First Name:
PATRICK
Provider Middle Name:
EDDIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LISW
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:
1902899511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1229 C AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSKALOOSA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52577-4246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-672-3159
Provider Business Mailing Address Fax Number:
641-672-3259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 E ALTA VISTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTUMWA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52501-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-684-3138
Provider Business Practice Location Address Fax Number:
641-684-3198
Provider Enumeration Date:
08/30/2005

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: 104100000X , with the licence number:  00915 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 42068106069 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 800009681 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 48694 . This is a "WELLMARK, INC BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: I006 . This is a "TRIWEST" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0272740 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145825 . This is a "HEALTH SOLUTIONS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 42068106069 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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