1598725905 NPI number — SIBLEY MEDICAL CENTER

Table of content: MICHAEL GENE MELDER II CRNA (NPI 1336631704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598725905 NPI number — SIBLEY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIBLEY MEDICAL CENTER
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:
1598725905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 W CHANDLER ST
Provider Second Line Business Mailing Address:
P.O. BOX 620
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55307-2127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-964-2271
Provider Business Mailing Address Fax Number:
507-964-8490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 SOUTH COUNTY ROAD 33
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTHROP
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-647-5318
Provider Business Practice Location Address Fax Number:
507-647-2118
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PHELPS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
952-442-2191

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , 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: 248648200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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