1629181094 NPI number — JANICE LEA FLEMING MD

Table of content: DR. ALKA KOHLI M.D (NPI 1699723999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629181094 NPI number — JANICE LEA FLEMING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEMING
Provider First Name:
JANICE
Provider Middle Name:
LEA
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:
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:
1629181094
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18895 BEROUN CROSSING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINE CITY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-629-6692
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 S HWY 65
Provider Second Line Business Practice Location Address:
KANABEE HOSPITAL
Provider Business Practice Location Address City Name:
MORA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-679-1212
Provider Business Practice Location Address Fax Number:
320-225-3429
Provider Enumeration Date:
08/17/2006

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: 207R00000X , with the licence number:  19089 , 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: 110193772 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 73D27FL . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0404572 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 164400 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 102897900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 73D28FL . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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