1508835133 NPI number — ALLUMA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508835133 NPI number — ALLUMA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLUMA, 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:
1508835133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603 BRUCE STREET
Provider Second Line Business Mailing Address:
PO BOX 603
Provider Business Mailing Address City Name:
CROOKSTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56716-0603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-281-3940
Provider Business Mailing Address Fax Number:
218-281-6261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 BRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROOKSTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-281-3940
Provider Business Practice Location Address Fax Number:
218-281-6261
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REITMEIER
Authorized Official First Name:
SHAUNA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
218-281-3940

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  8017741MHC , 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: 054855300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 93272 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CC6573 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116586 . This is a "UCARE MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1520165 . This is a "UBH MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 63592NO . This is a "BCBS BHSI" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 31167 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".




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