1790873412 NPI number — DIAMOND WOMEN'S CENTER, P.A.

Table of content: (NPI 1790873412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790873412 NPI number — DIAMOND WOMEN'S CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAMOND WOMEN'S CENTER, P.A.
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:
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:
1790873412
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:
6545 FRANCE AVE S
Provider Second Line Business Mailing Address:
SUITE 540
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-2131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-927-4045
Provider Business Mailing Address Fax Number:
952-924-4133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6545 FRANCE AVE S
Provider Second Line Business Practice Location Address:
SUITE 540
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-2131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-927-4045
Provider Business Practice Location Address Fax Number:
952-924-4133
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURGRAFF
Authorized Official First Name:
0PATRICIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
952-928-3677

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103752 . This is a "UCARE CLINIC PROVIDER #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 806 . This is a "HEALTPARTNERS PROV #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: FP100 . This is a "PREFFERED ONE PROVIDER #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 03451DI . This is a "BCBS PROVIDER #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: CP4302 . This is a "MEDICARE RR PALMETTO #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com