1164491908 NPI number — MR. GARY DAVID WEBSKOWSKI MPT

Table of content: MR. GARY DAVID WEBSKOWSKI MPT (NPI 1164491908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164491908 NPI number — MR. GARY DAVID WEBSKOWSKI MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBSKOWSKI
Provider First Name:
GARY
Provider Middle Name:
DAVID
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MPT
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:
1164491908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8100 NORTHLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55431-4800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-806-5619
Provider Business Mailing Address Fax Number:
952-806-5510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8100 NORTHLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55431-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-806-5619
Provider Business Practice Location Address Fax Number:
952-806-5510
Provider Enumeration Date:
03/15/2006

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: 2251X0800X , with the licence number:  6090 , 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: 059G6WE . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 104667 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6090 . This is a "MN STATE LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6576528 . This is a "AOA ST TAX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 989211040352 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP40440 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 411239729 . This is a "FEDERAL TAX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30701054 . This is a "PRIMWEST BILLING" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6404578 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 138399200 . This is a "ACS PROV" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00082826 . This is a "TRAVELERS MEDICARE" identifier . This identifiers is of the category "OTHER".




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