1427125475 NPI number — HOLLY MARIE GROSS PT

Table of content: HOLLY MARIE GROSS PT (NPI 1427125475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427125475 NPI number — HOLLY MARIE GROSS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROSS
Provider First Name:
HOLLY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1427125475
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5211 HIGHWAY 110
Provider Second Line Business Mailing Address:
ESSENTIA HEALTH NORTHERN PINES
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55705-1522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-229-2211
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 E 34TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIBBING
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55746-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-262-3425
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2006

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:  5727 , 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: 591R6GR . This is a "BSBS MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6404694 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 235786100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180022 . This is a "U CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6404694 . This is a "UNITED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611652900 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".




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