1245360619 NPI number — FAMILY & CHILDREN'S CENTER, INC

Table of content: (NPI 1245360619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245360619 NPI number — FAMILY & CHILDREN'S CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY & CHILDREN'S CENTER, INC
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:
1245360619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1707 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CROSSE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54601-4200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-785-0001
Provider Business Mailing Address Fax Number:
608-785-0002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2118 CAMPUS DR SE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55904-6492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-281-3508
Provider Business Practice Location Address Fax Number:
507-536-9317
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOEHM
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO, PRESIDENT
Authorized Official Telephone Number:
608-785-0001

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 49393700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163907000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 328L0FA . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HPFIN77035 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1388465J60 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".




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