1255377404 NPI number — SUSAN MARIE HARMAN PA-C

Table of content: SUSAN MARIE HARMAN PA-C (NPI 1255377404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255377404 NPI number — SUSAN MARIE HARMAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARMAN
Provider First Name:
SUSAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1255377404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5074
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57117-5074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 NORTH HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56143-1093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-847-2200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2006

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: 363A00000X , with the licence number:  9525 , 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: 228693 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6279 . This is a "AVERA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 71091 . This is a "WELLMARK BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 228693 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 20540 . This is a "SANFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00605698 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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