1518950815 NPI number — THERAPEUTIC INTERVENTION PROGRAMS, INC.

Table of content: (NPI 1518950815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518950815 NPI number — THERAPEUTIC INTERVENTION PROGRAMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPEUTIC INTERVENTION PROGRAMS, 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:
1518950815
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10721 SMETANA RD
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
MINNETONKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55343-8080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-936-9215
Provider Business Mailing Address Fax Number:
952-936-9942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10721 SMETANA RD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
MINNETONKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55343-8080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-936-9215
Provider Business Practice Location Address Fax Number:
952-936-9942
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MONTGOMERY
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
952-936-9215

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  03158 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 164018 . This is a "MN U CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 25G91TH . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1013116 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 64308 . This is a "MEDICA HEALTH PLANS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 60846086 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 899 . This is a "HEALTHPARTNERS, INC." identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 11880MO . This is a "BLUECROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 34155928 . This is a "PATIENT CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7G855TH . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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