1346302742 NPI number — DR. ANTHONY JOHN BART DC CCSP

Table of content: DR. ANTHONY JOHN BART DC CCSP (NPI 1346302742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346302742 NPI number — DR. ANTHONY JOHN BART DC CCSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BART
Provider First Name:
ANTHONY
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC CCSP
Provider Gender Code:
M

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:
1346302742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 EAST PARK STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELDON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51201-1275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-324-4994
Provider Business Mailing Address Fax Number:
712-324-3710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 EAST PARK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELDON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51201-1275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-324-4994
Provider Business Practice Location Address Fax Number:
712-324-3710
Provider Enumeration Date:
12/14/2006

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:  A05481 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9204458 . This is a "GRP DAKOTACARE DESIGN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 58536 . This is a "WELLMARK BLUE CROSS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 7262 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21568 . This is a "SIOUX VALLEY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2294553 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: C05481 . This is a "DAKOTACARE DESIGN" identifier . This identifiers is of the category "OTHER".




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