1306993183 NPI number — DR. KIMBERLY SWANSON-BUFFIE D.C.

Table of content: DR. KIMBERLY SWANSON-BUFFIE D.C. (NPI 1306993183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306993183 NPI number — DR. KIMBERLY SWANSON-BUFFIE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWANSON-BUFFIE
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUFFIE
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1306993183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55373-0207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-477-4266
Provider Business Mailing Address Fax Number:
763-477-6228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8340 BRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55373-9578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-477-4266
Provider Business Practice Location Address Fax Number:
763-477-6228
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3021 , 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: 407028300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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