1922025907 NPI number — ANU G GABA MD

Table of content: (NPI 1194936377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922025907 NPI number — ANU G GABA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GABA
Provider First Name:
ANU
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1922025907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 4TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58122-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-234-6161
Provider Business Mailing Address Fax Number:
701-234-7257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 4TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58122-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-234-6161
Provider Business Practice Location Address Fax Number:
701-234-7257
Provider Enumeration Date:
07/16/2006

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: 207RH0003X , with the licence number:  9598 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RH0003X , with the licence number: 47654 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 567465400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 820S4GA . This is a "MN BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP42398 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1041215 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13055 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24359 . This is a "NDBCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3600498 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7714340 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com