1588799738 NPI number — WIOLETA ELZBIETA MAZURCZAK MD

Table of content: (NPI 1942778063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588799738 NPI number — WIOLETA ELZBIETA MAZURCZAK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAZURCZAK
Provider First Name:
WIOLETA
Provider Middle Name:
ELZBIETA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEWPORANY
Provider Other First Name:
WIOLETA
Provider Other Middle Name:
ELZBIETA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588799738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 86370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57118-6370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-322-7510
Provider Business Mailing Address Fax Number:
605-322-6475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 W 69TH ST
Provider Second Line Business Practice Location Address:
STE 1500
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57108-8170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-322-5700
Provider Business Practice Location Address Fax Number:
605-322-5704
Provider Enumeration Date:
02/21/2007

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: 2084P0804X , with the licence number:  7102 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12200 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1588799738 . This is a "ARAZ/ AMERICA'S PPO" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 708402000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7101960 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 412991052723 . This is a "PREFERRED ONE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4992668 . This is a "BCBS SOUTH DAKOTA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 46022474352 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040121002 . This is a "PRIMEWEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 370624200 . This is a "DEPT. OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57108C036 . This is a "WPS TRICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 61408 . This is a "SANFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7102 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: HP83890 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 254722 . This is a "MIDLAND'S CHOICE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6I497MA . This is a "CC SYSTEMS/ BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6I497MA . This is a "BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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