1275859159 NPI number — ASSOCIATES IN ORAL AND MAXILLOFACIAL SURGERY, P.A.

Table of content: (NPI 1275859159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275859159 NPI number — ASSOCIATES IN ORAL AND MAXILLOFACIAL SURGERY, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATES IN ORAL AND MAXILLOFACIAL SURGERY, 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:
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:
1275859159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2717 SUPERIOR DR NW
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55901-3035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-281-5820
Provider Business Mailing Address Fax Number:
507-282-6543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2717 SUPERIOR DR NW
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55901-3035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-281-5820
Provider Business Practice Location Address Fax Number:
507-282-6543
Provider Enumeration Date:
04/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
VICKERS
Authorized Official First Name:
MARGY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
504-281-5820

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , 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: 857932600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06D38MA . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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