1992766026 NPI number — DR. BRYAN J HAMMER M.D.

Table of content: DR. BRYAN J HAMMER M.D. (NPI 1992766026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992766026 NPI number — DR. BRYAN J HAMMER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMMER
Provider First Name:
BRYAN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
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:
1992766026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6601 S MINNESOTA AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57108-2564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-336-6294
Provider Business Mailing Address Fax Number:
605-336-0266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6601 S MINNESOTA AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-336-6294
Provider Business Practice Location Address Fax Number:
605-336-0266
Provider Enumeration Date:
03/29/2006

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: 207WX0200X , with the licence number:  3744 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 3744 , 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: 532S8HA . This is a "BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6300060 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 797818900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02178 . This is a "WELLMARK OF SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 123562 . This is a "UCARE MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 18058 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3744 . This is a "DAKOTACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 46031185613 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6T52OHA . This is a "BLUE SHIELD OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 503-90-1755 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP76194 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0003031 . This is a "WELLMARK OF IA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0927822 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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