1881703486 NPI number — COUNTY OF CLEARWATER

Table of content: DR. JAMES P VAN EYK D.D.S. (NPI 1215152376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881703486 NPI number — COUNTY OF CLEARWATER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF CLEARWATER
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:
CLEARWATER COUNTY NURSING SERVICE
Provider Other Organization Name Type Code:
3
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:
1881703486
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:
212 MAIN AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAGLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56621-8313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-694-6581
Provider Business Mailing Address Fax Number:
218-694-6594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 MAIN AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAGLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56621-8313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-694-6581
Provider Business Practice Location Address Fax Number:
218-694-6594
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ENGEN
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
218-694-6581

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  330351 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251G00000X , with the licence number: 333488 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251K00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 5900209 . This is a "HOME HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8300122 . This is a "PUBLIC HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8233CL . This is a "HOME HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8G491CL . This is a "PUBLIC HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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