1528148087 NPI number — LOREN E. NOVAK & ASSOCIATES, INC

Table of content: (NPI 1528148087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528148087 NPI number — LOREN E. NOVAK & ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOREN E. NOVAK & ASSOCIATES, 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:
6
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:
1528148087
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:
16511 ANNA TRL SE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
PRIOR LAKE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55372-4533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-447-1117
Provider Business Mailing Address Fax Number:
952-447-1116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55024-1558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-460-8085
Provider Business Practice Location Address Fax Number:
651-463-8816
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALBERG
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
952-447-1117

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  830960-1 , 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: NA . This is a "CIGNA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 9363JO . This is a "BC/BS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8451554 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29692 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: U-CARE . This is a "103171" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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