1538114079 NPI number — VILLAGE OF BALDWIN

Table of content: DR. MICHELE MARIE VAN HIRTUM-DAS M.D. (NPI 1972605772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538114079 NPI number — VILLAGE OF BALDWIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF BALDWIN
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:
1538114079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 138
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALDWIN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54002-0138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 HIGHWAY 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALDWIN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-684-3188
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOYER
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
715-684-3188

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41332600 . This is a "HIRSP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 7047384 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000083953 . This is a "ADVOCARE MCHMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8180302 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 590156514 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 397267400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: WI0100 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1037070 . This is a "PHYSICIAN'S PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41332600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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