1225371701 NPI number — MEDICATION THERAPY MANAGEMENT INC. P.C.

Table of content: (NPI 1225371701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225371701 NPI number — MEDICATION THERAPY MANAGEMENT INC. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICATION THERAPY MANAGEMENT INC. P.C.
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:
1225371701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1320 ITHILIEN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXCELSIOR
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55331-9032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-301-6867
Provider Business Mailing Address Fax Number:
952-474-3220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1320 ITHILIEN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EXCELSIOR
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55331-9032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-301-6867
Provider Business Practice Location Address Fax Number:
952-474-3220
Provider Enumeration Date:
04/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
TSUHUA
Authorized Official Middle Name:
SUSAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
507-301-6867

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: 264077 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2141905 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2432083 . This is a "NCPDP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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