1902985906 NPI number — THE WINKLEY COMPANY

Table of content: (NPI 1902985906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902985906 NPI number — THE WINKLEY COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE WINKLEY COMPANY
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:
1902985906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
740 DOUGLAS DR N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDEN VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55422-4301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-546-1177
Provider Business Mailing Address Fax Number:
763-847-9508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 E 26TH ST
Provider Second Line Business Practice Location Address:
SUITE 323
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404-4526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-863-8963
Provider Business Practice Location Address Fax Number:
612-863-8962
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRUMAN
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
763-546-1177

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  NONE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41776500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 761972000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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