1912093881 NPI number — NORTH CENTRAL UROLOGY PC

Table of content: (NPI 1912093881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912093881 NPI number — NORTH CENTRAL UROLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CENTRAL UROLOGY PC
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:
1912093881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 S MINNESOTA 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:
57105-1723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-331-4493
Provider Business Mailing Address Fax Number:
605-331-0038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 S MINNESOTA 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:
57105-1723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-331-4493
Provider Business Practice Location Address Fax Number:
605-331-0038
Provider Enumeration Date:
10/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JANET
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
605-331-4493

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  0284 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7K9402M . This is a "MN BCBS JANET SMITH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4996954 . This is a "IA BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 709085400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0284 . This is a "SD BOARD OF MEDICAL EXAM" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4334139 . This is a "AETNA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: S40024 . This is a "PTAN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 0040053 . This is a "IA BCBS JANET SMITH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 7K939NO . This is a "MN BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0989319 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6821984 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".