1982796421 NPI number — AMIE R RYBACKI MPT

Table of content: AMIE R RYBACKI MPT (NPI 1982796421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982796421 NPI number — AMIE R RYBACKI MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYBACKI
Provider First Name:
AMIE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARROLL
Provider Other First Name:
AMIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982796421
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 261
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54025-0261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-245-5898
Provider Business Mailing Address Fax Number:
715-245-5898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
242 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54025-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-245-5898
Provider Business Practice Location Address Fax Number:
715-245-5898
Provider Enumeration Date:
09/29/2006

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: 225100000X , with the licence number:  6001 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41810700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6404866 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 288K7RY . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP49268 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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