1679578157 NPI number — MR. SCOTT KNUTSON DPM

Table of content: MR. SCOTT KNUTSON DPM (NPI 1679578157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679578157 NPI number — MR. SCOTT KNUTSON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNUTSON
Provider First Name:
SCOTT
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1679578157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6625 LYNDALE AVE S STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHFIELD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55423-2491
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-788-8778
Provider Business Mailing Address Fax Number:
612-869-3473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6625 LYNDALE AVE S STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHFIELD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55423-2673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-788-8778
Provider Business Practice Location Address Fax Number:
612-869-3473
Provider Enumeration Date:
06/20/2005

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: 213E00000X , with the licence number:  427 , 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: 0491043 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0808750001 . This is a "MEDICARE DMERC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 236266000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480000572 . This is a "TRAVELERS RAILROAD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 213825500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: C02581 . This is a "MEDICARE GROUP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: P00309735 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: CS1038 . This is a "TRAVELERS RAILROAD GROUP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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