1548426463 NPI number — ZION LLC

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 1548426463 NPI number — ZION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZION LLC
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:
1548426463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2403 STEWART AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55116-3036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-481-6005
Provider Business Mailing Address Fax Number:
651-698-9466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2403 STEWART AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55116-3036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-481-6001
Provider Business Practice Location Address Fax Number:
651-698-9466
Provider Enumeration Date:
07/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ATEM
Authorized Official First Name:
VALLANTINE
Authorized Official Middle Name:
EBOT
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
612-481-6005

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  R183439-8 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X , with the licence number: L061734-1 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 263982000 . This is a "MDHS(DHS)" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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