1750360004 NPI number — DR. ANDREW C HILLE DMD

Table of content: DR. ANDREW C HILLE DMD (NPI 1750360004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750360004 NPI number — DR. ANDREW C HILLE DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILLE
Provider First Name:
ANDREW
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
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:
1750360004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 S SOUTHEASTERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57103-3227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-331-5059
Provider Business Mailing Address Fax Number:
605-275-6725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 S SOUTHEASTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57103-3227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-331-5059
Provider Business Practice Location Address Fax Number:
605-275-6725
Provider Enumeration Date:
01/14/2006

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: 1223S0112X , with the licence number:  S0401 , 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: 8000463 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104737 . This is a "HEALTH PARTNERSPRACTICE #" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4995199 . This is a "BLUECBLUES PROVIDER #" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 8000462 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7809990 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8000460 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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