1619986171 NPI number — JENNIFER KAY FORD OTR/L

Table of content: JENNIFER KAY FORD OTR/L (NPI 1619986171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619986171 NPI number — JENNIFER KAY FORD OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORD
Provider First Name:
JENNIFER
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

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:
1619986171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3810 NEW BRIGHTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARDEN HILLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55112-3213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-264-9814
Provider Business Mailing Address Fax Number:
651-738-9889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1687 WOODLANE DR STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55125-3047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-264-9814
Provider Business Practice Location Address Fax Number:
651-738-9889
Provider Enumeration Date:
08/05/2006

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: 225X00000X , with the licence number:  100769 , 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: 6406266 . This is a "MEDICA PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 41031600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 094H7FO . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2442958 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP61130 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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