1548369606 NPI number — DR. DAVID RITLAND TVERBERG M.D.

Table of content: (NPI 1467622415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548369606 NPI number — DR. DAVID RITLAND TVERBERG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TVERBERG
Provider First Name:
DAVID
Provider Middle Name:
RITLAND
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1548369606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 FLORENCE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWATONNA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55060-4704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-455-7644
Provider Business Mailing Address Fax Number:
507-455-7662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 FLORENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWATONNA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55060-4704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-451-2630
Provider Business Practice Location Address Fax Number:
507-455-8133
Provider Enumeration Date:
09/22/2006

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: 2084P0800X , with the licence number:  33449 , 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: 3K744TV . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 269000246 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 689805000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP18407 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 15-20385 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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