1679632988 NPI number — RS LYLE HILLMAN MD

Table of content: RS LYLE HILLMAN MD (NPI 1679632988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679632988 NPI number — RS LYLE HILLMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILLMAN
Provider First Name:
RS
Provider Middle Name:
LYLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1679632988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
737 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58122-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-234-2309
Provider Business Mailing Address Fax Number:
701-234-7154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
737 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58122-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-234-2309
Provider Business Practice Location Address Fax Number:
701-234-7154
Provider Enumeration Date:
12/06/2006

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: 2085R0202X , with the licence number:  2779 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 24193 . This is a "NDBCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 781S8HI . This is a "MN BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP40989 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1602878 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12681 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1040824 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com