1023179033 NPI number — GREAT PLAINS EMS, INC.

Table of content: DR. ISABEL ODEIDA VELEZ M.D. (NPI 1992194906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023179033 NPI number — GREAT PLAINS EMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREAT PLAINS EMS, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1023179033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 388
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THIEF RIVER FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56701-0388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-281-6332
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 W LORING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROOKSTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56716-1943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-281-6332
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TALLACKSON
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLAIMS MANAGER
Authorized Official Telephone Number:
218-281-6332

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8G858GR . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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