1023103421 NPI number — WILLIAM C ELDER M.D.

Table of content: WILLIAM C ELDER M.D. (NPI 1023103421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023103421 NPI number — WILLIAM C ELDER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELDER
Provider First Name:
WILLIAM
Provider Middle Name:
C
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:
1023103421
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 HIGHWAY 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HETTINGER
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58639-7533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-567-4561
Provider Business Mailing Address Fax Number:
701-567-6301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 HIGHWAY 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HETTINGER
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-567-4561
Provider Business Practice Location Address Fax Number:
701-567-6301
Provider Enumeration Date:
10/03/2006

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:  3444 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 33265 . This is a "SIOUX VALLEY" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 10771 . This is a "ND BLUECROSS/BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 12816 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3018140 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7776060 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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