1982756169 NPI number — DR RONN MCDANIEL PA

Table of content: (NPI 1982756169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982756169 NPI number — DR RONN MCDANIEL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR RONN MCDANIEL PA
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:
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:
1982756169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 E 25TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIBBING
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55746-3897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-839-3413
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
128 2ND ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORTONVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56278-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-839-3413
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCDANIEL
Authorized Official First Name:
RONN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
320-839-3413

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2619 , 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: 9200830 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: DP3657 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2212701 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5C859MC . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 121080 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5C856MC . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 848152100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: S42523 . This is a "NORIDIAN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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