1205951415 NPI number — RICHARD J. DANNENBERG

Table of content: (NPI 1205951415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205951415 NPI number — RICHARD J. DANNENBERG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD J. DANNENBERG
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:
6
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:
1205951415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2023 S BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ULM
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56073-3954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-233-3500
Provider Business Mailing Address Fax Number:
507-354-7562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2023 S BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ULM
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56073-3954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-233-3500
Provider Business Practice Location Address Fax Number:
507-354-7562
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DANNENBERG
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
507-233-3500

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  27830 , 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: 110565 . This is a "EYEMED" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 826041022794 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0808759 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 114683 . This is a "U-CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5C212DA . This is a "BCBS BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 475067500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19379 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 43034DA . This is a "BCBSMN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com