1114094620 NPI number — HEALTHPARTNERS RC

Table of content: (NPI 1114094620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114094620 NPI number — HEALTHPARTNERS RC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHPARTNERS RC
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:
1114094620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HEALTHY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLIVIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56277-1117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-523-1261
Provider Business Mailing Address Fax Number:
320-523-8349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HEALTHY WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLIVIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56277-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-523-1261
Provider Business Practice Location Address Fax Number:
320-523-3458
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLAD
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
320-523-3575

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  331046 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 315D00000X , with the licence number: 331046 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 304706539 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 072262101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 502347500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2457 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 404706548 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5529420 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: H4160068805 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 268517500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80617900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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