1568546992 NPI number — REGENTS OF THE UNIVERSITY OF MINNESOTA

Table of content: (NPI 1568546992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568546992 NPI number — REGENTS OF THE UNIVERSITY OF MINNESOTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENTS OF THE UNIVERSITY OF MINNESOTA
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:
1568546992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 E 25TH ST
Provider Second Line Business Mailing Address:
ROOM C-153
Provider Business Mailing Address City Name:
HIBBING
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55746-3354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-263-2917
Provider Business Mailing Address Fax Number:
218-263-2971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 E 25TH ST
Provider Second Line Business Practice Location Address:
ROOM C-153
Provider Business Practice Location Address City Name:
HIBBING
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55746-3354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-263-2917
Provider Business Practice Location Address Fax Number:
218-263-2971
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
GARY
Authorized Official Middle Name:
CARL
Authorized Official Title or Position:
DEAN
Authorized Official Telephone Number:
612-626-6529

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 936450100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com