1912993049 NPI number — CAROLINE GEORGE MD

Table of content: CAROLINE GEORGE MD (NPI 1912993049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912993049 NPI number — CAROLINE GEORGE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGE
Provider First Name:
CAROLINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GEORGE
Provider Other First Name:
CAROLINE
Provider Other Middle Name:
LEE SISOLA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912993049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 WASHINGTON AVE 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:
55414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-884-0649
Provider Business Mailing Address Fax Number:
612-676-8992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2450 RIVERSIDE AVE S0
Provider Second Line Business Practice Location Address:
CENTER FOR PEDIATRIC BLOOD AND MARROW TRANSPLATION
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55454-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-365-6777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0203X , with the licence number:  32474 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0203X , with the licence number: 49726 , 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: 45387 . This is a "WELLMARK BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0174292 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".