1942395702 NPI number — JORZACH INC

Table of content: (NPI 1942395702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942395702 NPI number — JORZACH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JORZACH INC
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:
1942395702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
878 6TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAWSON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-769-2977
Provider Business Mailing Address Fax Number:
320-769-4322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
878 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAWSON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-769-2977
Provider Business Practice Location Address Fax Number:
320-769-4322
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLAND
Authorized Official First Name:
LISA
Authorized Official Middle Name:
LEEANN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
320-769-2977

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2671 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 2670 , 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: 044714500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163J8HE . This is a "BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 97204 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 163J7HE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 126236 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 114766 . This is a "UCARE MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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