1225048176 NPI number — SONYA A TOURVILLE DC

Table of content: SONYA A TOURVILLE DC (NPI 1225048176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225048176 NPI number — SONYA A TOURVILLE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOURVILLE
Provider First Name:
SONYA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTH-TOURVILLE
Provider Other First Name:
SONYA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1225048176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55363-0406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-675-3121
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 NELSON BLVD STE 1000
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-675-3121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2892 , 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: 7875640 . This is a "AETNA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 386328000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231445 . This is a "CHIROCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 350052039 . This is a "RR MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0287000044 . This is a "HSM" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3K701TO . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4448016 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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