1952557134 NPI number — GREGG C HEBEISEN D.C.

Table of content: GREGG C HEBEISEN D.C. (NPI 1952557134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952557134 NPI number — GREGG C HEBEISEN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEBEISEN
Provider First Name:
GREGG
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1952557134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6280 HIGHWAY 65 NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRIDLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55432-5188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-571-9499
Provider Business Mailing Address Fax Number:
763-502-0364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6280 HIGHWAY 65 NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRIDLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55432-5188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-571-9499
Provider Business Practice Location Address Fax Number:
763-502-0364
Provider Enumeration Date:
08/07/2008

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: 111N00000X , with the licence number:  DC2214 , 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: 1026232 . This is a "PAS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 13N21HE . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 44448225 . This is a "MEDICA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 665950 . This is a "AMERICAS PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 665950 . This is a "DEFINITY HEALTH" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 237P3HE . This is a "BLUECROSS BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13N31HE . This is a "BLUECROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 767527500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01005230 . This is a "PREFERED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4425650 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 47676807801 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 230321 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 231414 . This is a "AMERICAN SPECIALTY HEALTH GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 377 . This is a "HEALTH SERVICE MGMT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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