1134165244 NPI number — THERESA MAKOONS-SOLARZ MS LP

Table of content: THERESA MAKOONS-SOLARZ MS LP (NPI 1134165244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134165244 NPI number — THERESA MAKOONS-SOLARZ MS LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAKOONS-SOLARZ
Provider First Name:
THERESA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS LP
Provider Gender Code:
F

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:
1134165244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
911 18TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56303-1203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-650-1660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
911 18TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303-1203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-252-5010
Provider Business Practice Location Address Fax Number:
320-203-1855
Provider Enumeration Date:
06/20/2006

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: 103T00000X , with the licence number:  LP3933 , 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: 110609C851 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP25555 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7H83350 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 934527200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1134165244 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 922241022572 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6239970 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".




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