1982717567 NPI number — JAMES R HAEBERLIN M.D.

Table of content: JAMES R HAEBERLIN M.D. (NPI 1982717567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982717567 NPI number — JAMES R HAEBERLIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAEBERLIN
Provider First Name:
JAMES
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1982717567
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 S MILL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERGUS FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56537-2756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-739-2221
Provider Business Mailing Address Fax Number:
218-739-5501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 S MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERGUS FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56537-2756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-739-2221
Provider Business Practice Location Address Fax Number:
218-739-5501
Provider Enumeration Date:
08/16/2006

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: 208600000X , with the licence number:  46990 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1041963 . This is a "PREFERRED ONE NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 132318 . This is a "U-CARE NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 091256 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3700042 . This is a "MEDICA NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 41091744413 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 485T3HA . This is a "BCBS NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 13656 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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