1376507061 NPI number — ANODYNE, INC.

Table of content: (NPI 1376507061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376507061 NPI number — ANODYNE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANODYNE, INC.
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:
1376507061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6024 BLUE CIRCLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNETONKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55343-9104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-546-5334
Provider Business Mailing Address Fax Number:
952-546-2657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6024 BLUE CIRCLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNETONKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55343-9104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-546-5334
Provider Business Practice Location Address Fax Number:
952-546-2657
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARZOLF
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
952-546-5334

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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: 773232 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0987065 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104225 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 39026 . This is a "WAUSAU BENEFITS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 403363900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 59255AN . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8200161 . This is a "MEDICA MSHO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 403363900 . This is a "MN COUNTY WAIVERED SVCS." identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8200161 . This is a "MEDICACHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 130869 . This is a "HENNEPIN COUNTY WAIVERED" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 52190 . This is a "SPECIALTY RISK SERVICES" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 76185C001 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 106040400 . This is a "ACS FEDERAL WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1411901281 . This is a "PRIME WEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 41682300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1040355 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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