1821172123 NPI number — DR. JOHN RILEY MCCARTEN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821172123 NPI number — DR. JOHN RILEY MCCARTEN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MCCARTEN

Provider First Name:

JOHN

Provider Middle Name:

RILEY

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1821172123

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/31/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

420 DELAWARE STREET SE

Provider Second Line Business Mailing Address:

UNIVERSITY OF MINNESOTA PHYSICIANS

Provider Business Mailing Address City Name:

MINNEAPOLIS

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55455

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-467-3314

Provider Business Mailing Address Fax Number:

612-725-2084

Provider First Line Business Practice Location Address:

ONE VETERANS' DRIVE MINNEAPOLIS VAMC

Provider Second Line Business Practice Location Address:

GERIATRIC RESEARCH EDUCATION AND CLINICAL CENTER, 11-G

Provider Business Practice Location Address City Name:

MINNEAPOLIS

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55417

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

612-467-3314

Provider Business Practice Location Address Fax Number:

612-725-2084

Provider Enumeration Date:

10/24/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2084N0400X , with the licence number:  27166 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 135526 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 05-00009 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1498290 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 642688300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 694T8MC . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: B697 . This is a "CHAMPUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 05-00699 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1045660 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 34802700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
• Identifier: HP58157 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 0147758 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 0599795 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".