1164557799 NPI number — BIOFEEDBACK TRAINING AND TREATMENT CENTER, INC.

Table of content: (NPI 1164557799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164557799 NPI number — BIOFEEDBACK TRAINING AND TREATMENT CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIOFEEDBACK TRAINING AND TREATMENT CENTER, INC.
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:
BIOFEEDBACK CENTER OF MINNESOTA
Provider Other Organization Name Type Code:
3
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:
1164557799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5001 AMERICAN BLVD W STE 980
Provider Second Line Business Mailing Address:
BIOFEEDBACK TRAINING & TREATMENT CENTER, INC.
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55437-1164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-893-9400
Provider Business Mailing Address Fax Number:
952-698-3532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5001 AMERICAN BLVD W STE 980
Provider Second Line Business Practice Location Address:
BIOFEEDBACK TRAINING & TREATMENT CENTER, INC.
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55437-1164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-893-9400
Provider Business Practice Location Address Fax Number:
952-698-3532
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JEFFREY-SMITH
Authorized Official First Name:
LILLI
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CENTER DIRECTOR
Authorized Official Telephone Number:
952-893-9400

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01458BI . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 623080001 . This is a "CIGNA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 04004001 . This is a "METROPOLITAN HEALTH PLAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3948 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01-23460 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 31800 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7963785-00 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9657479-00 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00014 . This is a "SELECT CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4544126 . This is a "AETNA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 109585 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3D4274BE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 49-80023 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 88G75HA . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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