1447324512 NPI number — MRS. ARDITH ANN MESSICCI MA LP

Table of content: MRS. ARDITH ANN MESSICCI MA LP (NPI 1447324512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447324512 NPI number — MRS. ARDITH ANN MESSICCI MA LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MESSICCI
Provider First Name:
ARDITH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA LP
Provider Gender Code:
F

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:
1447324512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3724 AUGER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE BEAR LAKE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55110-4617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-429-1326
Provider Business Mailing Address Fax Number:
763-494-8797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13700 83RD WAY
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
MAPLE GROVE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55369-7015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-494-8699
Provider Business Practice Location Address Fax Number:
763-494-8797
Provider Enumeration Date:
11/20/2006

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: 103T00000X , with the licence number:  LP0951 , 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: 6229932 . This is a "UBH MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1012797 . This is a "PREF 1" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: PS1226 . This is a "AMERICAS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3H756ME . This is a "BC BS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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