1952370348 NPI number — CITY OF SLEEPY EYE

Table of content: (NPI 1952370348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952370348 NPI number — CITY OF SLEEPY EYE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SLEEPY EYE
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:
SLEEPY EYE MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1952370348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 4TH AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLEEPY EYE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56085-1109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-794-3571
Provider Business Mailing Address Fax Number:
507-794-5950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 4TH AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLEEPY EYE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56085-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-794-3571
Provider Business Practice Location Address Fax Number:
507-794-5950
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SELLHEIM
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
ADMINISTRATOR/CEO
Authorized Official Telephone Number:
507-794-8440

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  327647 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 327647 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 327647 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 0915450001 , 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: 400031 . This is a "UCARE PROF FEE-H152" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1014192 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6340860 . This is a "AETNA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5025400 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60933SL . This is a "DME-BLUE CROSS BLUE SHIEL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 300730 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 315045300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1856HSL . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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