1306921275 NPI number — JOHN N. O'NEIL, PH.D., L.P., LLC

Table of content: (NPI 1306921275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306921275 NPI number — JOHN N. O'NEIL, PH.D., L.P., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN N. O'NEIL, PH.D., L.P., LLC
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:
1306921275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 NICOLLET MALL
Provider Second Line Business Mailing Address:
1735 MEDICAL ARTS BUILDING
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55402-2704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-455-6167
Provider Business Mailing Address Fax Number:
612-333-6740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 NICOLLET MALL
Provider Second Line Business Practice Location Address:
1735 MEDICAL ARTS BUILDING
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55402-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-455-6167
Provider Business Practice Location Address Fax Number:
612-333-6740
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'NEIL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
NOLEN
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST
Authorized Official Telephone Number:
612-455-6167

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  LP4307 , 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: 169041 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6169449 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 013764200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49F69ON . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP40630 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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