1467431585 NPI number — DR. JEFFREY HENRY ALTO MD

Table of content: DR. JEFFREY HENRY ALTO MD (NPI 1467431585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467431585 NPI number — DR. JEFFREY HENRY ALTO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALTO
Provider First Name:
JEFFREY
Provider Middle Name:
HENRY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1467431585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 S MAPLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACONIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55387-1752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
524-422-1919
Provider Business Mailing Address Fax Number:
952-442-8055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 S 4TH ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LE SUEUR
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56058-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-593-5920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2006

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: 207R00000X , with the licence number:  39907 , 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: 110170017 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29B00AL . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 273961500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0408405 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP23870 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1092848 . This is a "AMERICAS PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 120959 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: NA2951023809 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 41084933956001C124 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".




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