1487606067 NPI number — MR. BERISLAV SPAHIJA MD

Table of content: MR. BERISLAV SPAHIJA MD (NPI 1487606067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487606067 NPI number — MR. BERISLAV SPAHIJA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPAHIJA
Provider First Name:
BERISLAV
Provider Middle Name:
Provider Name Prefix Text:
MR.
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:
1487606067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 E CENTER ST # 2595
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57042-2908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-204-1130
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 N 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58501-4436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-323-5332
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2006

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: 2084N0400X , with the licence number:  35077285 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1047518 . This is a "WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 130021621 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34190968600 . This is a "WORKERS COMP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 774691 . This is a "BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1510739 . This is a "GATEWAY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2260699 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0500696 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2150390 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2745739 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6120037000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: P77285 . This is a "HEALTH PLAN UPPER OH VALL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000142099 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000520339 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 95840 . This is a "QUAL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341909686026 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com