1265582423 NPI number — DALE AVIATION INC

Table of content: (NPI 1265582423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265582423 NPI number — DALE AVIATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALE AVIATION 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:
1265582423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 AIRPORT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAPID CITY
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57703-8700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-393-0300
Provider Business Mailing Address Fax Number:
605-393-0306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 AIRPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57703-8700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-393-0300
Provider Business Practice Location Address Fax Number:
605-393-0306
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
KRISTY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SECRETARY/TREASURER
Authorized Official Telephone Number:
605-393-0300

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0029 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X , with the licence number: 0029 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0099208 . This is a "BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 9020080 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9011520 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115513000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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