1184851115 NPI number — NATIVE AMERICAN COMMUNITY CLINIC

Table of content: AGNIESZKA J. NIEMEYER MD (NPI 1467635789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184851115 NPI number — NATIVE AMERICAN COMMUNITY CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIVE AMERICAN COMMUNITY CLINIC
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:
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:
1184851115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1213 E FRANKLIN AVE
Provider Second Line Business Mailing Address:
SUITE 201A
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55404-2923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-872-8086
Provider Business Mailing Address Fax Number:
612-872-8547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1213 E FRANKLIN AVE
Provider Second Line Business Practice Location Address:
SUITE 201A
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404-2923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-872-8086
Provider Business Practice Location Address Fax Number:
612-872-8547
Provider Enumeration Date:
06/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CAROS
Authorized Official First Name:
LYDIA
Authorized Official Middle Name:
BETH
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
612-872-8086

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , 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)





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