1780741942 NPI number — DR. DARCIA M DIERKING AU.D.

Table of content: DR. DARCIA M DIERKING AU.D. (NPI 1780741942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780741942 NPI number — DR. DARCIA M DIERKING AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIERKING
Provider First Name:
DARCIA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TIDEMANN
Provider Other First Name:
DARCIA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780741942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 RIVERSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55454-1450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-672-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2450 RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55454-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-672-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2007

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: 231H00000X , with the licence number:  147001331 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 214 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 9260 , 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: 06633 . This is a "BCBS BT" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 06634 . This is a "BCBS ENT" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1585323 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9585323 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7585323 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4585323 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0585323 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0585349 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1585349 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5585323 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2585349 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6585323 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3585323 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3585349 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8285323 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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