1750481958 NPI number — WEST CENTRAL INTERNAL MEDICINE

Table of content: DR. ALYSSA ANN TRAN D.M.D. (NPI 1124071873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750481958 NPI number — WEST CENTRAL INTERNAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST CENTRAL INTERNAL MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1750481958
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 E 7TH ST
Provider Second Line Business Mailing Address:
PO BOX 410
Provider Business Mailing Address City Name:
MORRIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56267-1312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-589-4008
Provider Business Mailing Address Fax Number:
320-589-4227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 E 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56267-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-589-4008
Provider Business Practice Location Address Fax Number:
320-589-4227
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STOCK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
320-589-4008

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  5706872 , 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: 0836930001 . This is a "DMERC CLINIC #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 121703 . This is a "UCARE CLINIC #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3T172WE . This is a "BLUE CROSS CLINIC #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 30843 . This is a "HEALTHPARTNERS CLINIC#" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: CN5505 . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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