1821202359 NPI number — PAYNESVILLE AREA HOSPITAL DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821202359 NPI number — PAYNESVILLE AREA HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAYNESVILLE AREA HOSPITAL DISTRICT
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:
GREEN LAKE MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
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:
1821202359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 HIGHWAY 23
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
SPICER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56288-4607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-796-5555
Provider Business Mailing Address Fax Number:
320-796-5558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 HIGHWAY 23
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
SPICER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56288-4607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-796-5555
Provider Business Practice Location Address Fax Number:
320-796-5558
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TEIGEN
Authorized Official First Name:
BOBBE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
320-243-3767

Provider Taxonomy Codes

  • Taxonomy code: 261QC0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com