1194760009 NPI number — EMERGENCY PHYSICIANS & CONSULTANTS, PA

Table of content: (NPI 1194760009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194760009 NPI number — EMERGENCY PHYSICIANS & CONSULTANTS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY PHYSICIANS & CONSULTANTS, PA
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:
1194760009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 81
Provider Second Line Business Mailing Address:
EMERGENCY PHYSICIANS & CONSULTANTS, PA
Provider Business Mailing Address City Name:
CHASKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55318-0081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 S MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WACONIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55387-1752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-442-2191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUBBARD
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
952-442-2191

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 39-22239 . This is a "MEDICA EMERG" identifier . This identifiers is of the category "OTHER".
  • Identifier: CS6766 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 143713500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00235001 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103677 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 66-22282 . This is a "MEDICA - UNITED HEALTHCAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15961 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95852EM . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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