1154317337 NPI number — CHARLES R BIGELOW PT

Table of content: CHARLES R BIGELOW PT (NPI 1154317337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154317337 NPI number — CHARLES R BIGELOW PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIGELOW
Provider First Name:
CHARLES
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1154317337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1530 ROWE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORTHINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56187-9700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-372-2232
Provider Business Mailing Address Fax Number:
507-372-7326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1530 ROWE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORTHINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56187-9700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-372-2232
Provider Business Practice Location Address Fax Number:
507-372-7326
Provider Enumeration Date:
09/23/2005

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: 225100000X , with the licence number:  2284 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 0469 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 483 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 03105 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 25806 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5830113 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25806 . This is a "ARAZ" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5830115 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64-08038 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 23143 . This is a "SIOUX VALLEY HEALTH PLANS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 64-08036 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 8B711BI . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4998544 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 64-05334 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8B711BI . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0469.1 . This is a "DAKOTACARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5830112 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64-03580 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0469.1 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 64-04224 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 64-08037 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 64-04206 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 3110 . This is a "AVERA HEALTH PLANS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 64-03864 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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