1427171636 NPI number — VALLEY SPINE CENTER, INC.

Table of content: (NPI 1427171636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427171636 NPI number — VALLEY SPINE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY SPINE CENTER, 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:
1427171636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 561
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAHPETON
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58074-0561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-642-6480
Provider Business Mailing Address Fax Number:
701-642-6011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 11TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAHPETON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58075-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-642-6480
Provider Business Practice Location Address Fax Number:
701-642-6011
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MITSKOG
Authorized Official First Name:
ALISA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
701-642-6480

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  289 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 750 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NS0005X , with the licence number: 500 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 24675 . This is a "BCBS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 922509900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25401 . This is a "BCBS DR. ROBB DOHMAN" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 17175 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 296001 . This is a "BCBS WAHPETON" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 634001 . This is a "BCBS LIDGERWOOD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 91002MI . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 13184 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13349 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16659600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 71653MI . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 25402 . This is a "BCBS DR. ALISA MITSKOG" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 500688100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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