1780900787 NPI number — JOSEPH DALE ULIN CRNA

Table of content: DESTINY SUZANNE DREHS RAD-T (NPI 1689342081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780900787 NPI number — JOSEPH DALE ULIN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ULIN
Provider First Name:
JOSEPH
Provider Middle Name:
DALE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1780900787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5045
Provider Second Line Business Mailing Address:
ATTN: PATIENT FINANCIAL SERVICES, ADP2
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57117-5045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-322-6428
Provider Business Mailing Address Fax Number:
605-322-6499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 E 21ST ST
Provider Second Line Business Practice Location Address:
AVERA MCKENNAN ANESTHESIOLOGY
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57105-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-322-2754
Provider Business Practice Location Address Fax Number:
605-322-2727
Provider Enumeration Date:
04/15/2010

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: 367500000X , with the licence number:  CR000743 , 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: 1780900787 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00883875 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 9293183 . This is a "DAKOTACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1780900787 . This is a "WELLMARK BCBS SD - TRICARE TRIWEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1780900787 . This is a "BCBS MN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1780900787 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2000120 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 46022474348 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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