1083798375 NPI number — DR. ANDREW WILLIAM ULVIN D.C.

Table of content: JEILY MENDEZ (NPI 1174161020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083798375 NPI number — DR. ANDREW WILLIAM ULVIN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ULVIN
Provider First Name:
ANDREW
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1083798375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 298
Provider Second Line Business Mailing Address:
P.O. BOX 237
Provider Business Mailing Address City Name:
STACY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55079-0298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-462-3243
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
397 BENCH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLORS FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55084-0237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-465-3190
Provider Business Practice Location Address Fax Number:
651-344-6025
Provider Enumeration Date:
10/24/2006

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: 111N00000X , with the licence number:  3840 , 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: 4488447 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 79229 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 350052900 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4292979-00 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 077J3TA . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 38939600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: U85229 . This is a "HEALTH EOS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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