1699858811 NPI number — THOMAS JOSEPH TRANNEL MD

Table of content: ATUSHA PATEL (NPI 1750455051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699858811 NPI number — THOMAS JOSEPH TRANNEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRANNEL
Provider First Name:
THOMAS
Provider Middle Name:
JOSEPH
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:
1699858811
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 WEST AVE S
Provider Second Line Business Mailing Address:
PHYSICIAN SERVICES
Provider Business Mailing Address City Name:
LA CROSSE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54601-4783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-392-4156
Provider Business Mailing Address Fax Number:
608-392-9898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 11TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA CROSSE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54601-4116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-392-9555
Provider Business Practice Location Address Fax Number:
608-392-9432
Provider Enumeration Date:
10/23/2006

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: 2084P0804X , with the licence number:  37852 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 37852 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 32240800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 127378 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 84G00TR . This is a "BCBS-MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP66205 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 390821863003 . This is a "TRICARE-HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81G02TR . This is a "BCBS-MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 953023100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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