1205970894 NPI number — ST. CROIX ORTHOPAEDICS, P.A.

Table of content: (NPI 1205970894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205970894 NPI number — ST. CROIX ORTHOPAEDICS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. CROIX ORTHOPAEDICS, P.A.
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:
1205970894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5803 NEAL AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK PARK HEIGHTS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55082-2177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-439-8807
Provider Business Mailing Address Fax Number:
651-439-0232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1715 TOWER DR. W SUITE 100
Provider Second Line Business Practice Location Address:
HEARTLAND CENTER
Provider Business Practice Location Address City Name:
STILLWATER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55082-7609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-275-4180
Provider Business Practice Location Address Fax Number:
651-275-2744
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LINDSTROM
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF ANCILLARY SERVICES
Authorized Official Telephone Number:
651-351-2728

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41657800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44582 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8G895BR . This is a "BLUE CROSS MN BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 9635801017818 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 942298600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102957 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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