1932298866 NPI number — CARRIE ANN TERRELL MD

Table of content: SYDNEY LADY (NPI 1023737582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932298866 NPI number — CARRIE ANN TERRELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERRELL
Provider First Name:
CARRIE
Provider Middle Name:
ANN
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:
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:
1932298866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
606 24TH AVE S SUITE 300
Provider Second Line Business Mailing Address:
RIVERSIDE PROF BLDG
Provider Business Mailing Address City Name:
MPLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-273-7111
Provider Business Mailing Address Fax Number:
612-273-7112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 24TH AVE S SUITE 300
Provider Second Line Business Practice Location Address:
RIVERSIDE PROF BLDG
Provider Business Practice Location Address City Name:
MPLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-273-7111
Provider Business Practice Location Address Fax Number:
612-273-7112
Provider Enumeration Date:
10/11/2006

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: 207V00000X , with the licence number:  40822 , 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: 095968 . This is a "FAIRVIEW" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1020433 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 123579 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0062458 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07-00036 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 248J9TE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 357724400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07-02916 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 852871 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP28745 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com