1811193188 NPI number — NEXUS

Table of content: (NPI 1811193188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811193188 NPI number — NEXUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEXUS
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:
1811193188
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:
4050 OLSON MEMORIAL HWY
Provider Second Line Business Mailing Address:
SUITE 450
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55422-5323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-551-8659
Provider Business Mailing Address Fax Number:
763-553-1637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CROSIER DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ONAMIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56359-4512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-532-4005
Provider Business Practice Location Address Fax Number:
320-532-4898
Provider Enumeration Date:
06/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
D'ANGELO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
763-551-8669

Provider Taxonomy Codes

  • Taxonomy code: 3245S0500X , with the licence number:  1036935-1-CRF , 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: 5160492 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5160493 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4C72MI . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5160490 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com