1093751323 NPI number — DR. MARK ROLLINS BIXBY M.D.

Table of content: DR. MARK ROLLINS BIXBY M.D. (NPI 1093751323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093751323 NPI number — DR. MARK ROLLINS BIXBY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIXBY
Provider First Name:
MARK
Provider Middle Name:
ROLLINS
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:
1093751323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8301 GOLDEN VALLEY ROAD, SUITE 300
Provider Second Line Business Mailing Address:
NORTH MEMORIAL HEALTH CARE - CLINIC SERVICES
Provider Business Mailing Address City Name:
GOLDEN VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55427-4484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-581-0908
Provider Business Mailing Address Fax Number:
952-767-2380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 39TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55421-4379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-706-2900
Provider Business Practice Location Address Fax Number:
612-706-2901
Provider Enumeration Date:
06/22/2006

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: 207Q00000X , with the licence number:  24754 , 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: OD081BI . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1000070 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01-22161 . This is a "MEDICA CHOICE & PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 102681 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 21797 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 524377700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP27055 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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