1477961019 NPI number — S SJOBERG PLC

Table of content: (NPI 1477961019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477961019 NPI number — S SJOBERG PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S SJOBERG PLC
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:
1477961019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 3RD AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROSBY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56441-1665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-546-5108
Provider Business Mailing Address Fax Number:
218-546-5736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7636 DESIGN RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
BAXTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56425-8677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-825-1976
Provider Business Practice Location Address Fax Number:
218-828-9869
Provider Enumeration Date:
07/28/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SJOBERG
Authorized Official First Name:
STACY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
218-546-5108

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WL0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WX0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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