1710957188 NPI number — MR. NATHAN HINKER CNP

Table of content: MR. NATHAN HINKER CNP (NPI 1710957188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710957188 NPI number — MR. NATHAN HINKER CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINKER
Provider First Name:
NATHAN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CNP
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:
1710957188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
265 MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORSICA
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57328-0028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-946-5411
Provider Business Mailing Address Fax Number:
605-946-5206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
265 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORSICA
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57328-0028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-946-5411
Provider Business Practice Location Address Fax Number:
605-946-5206
Provider Enumeration Date:
01/26/2006

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: 363L00000X , with the licence number:  0352 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5306742 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6824102 . This is a "MEDICAID NH" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: S1639 . This is a "MEDICARE PTAN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6693 . This is a "AVERA HEALTH" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4995919 . This is a "WELLMARK" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: P-11222864 . This is a "MULTIPLAN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 237243 . This is a "MIDLAND'S CHOICE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 01-14778 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 9237774 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: AH1141031593 . This is a "PREFERRED ONE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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