1285665877 NPI number — ASSOCIATED PSYCHOLOGICAL SERVICES

Table of content: (NPI 1285665877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285665877 NPI number — ASSOCIATED PSYCHOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED PSYCHOLOGICAL SERVICES
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:
1285665877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 E HICKORY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANKATO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56001-3630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-388-8114
Provider Business Mailing Address Fax Number:
507-388-8068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 E HICKORY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANKATO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56001-3630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-388-8114
Provider Business Practice Location Address Fax Number:
507-388-8068
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARSHALL
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
507-388-8114

Provider Taxonomy Codes

  • Taxonomy code: 103TB0200X , with the licence number:  LP3219 , 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: 121989 . This is a "UCARE PROV ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 136497 . This is a "UCARE GR#" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 755295500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060H0AS . This is a "BCBS GROUP #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6128537 . This is a "MEDICA-UBH PROV ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 84732 . This is a "HEALTH PARTNERS GR#" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: C05525 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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