Basic Information
Provider Information | |||||||||
NPI: | 1235191149 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STREI | ||||||||
FirstName: | ANITA | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 520 S. SIBLEY AVE | ||||||||
Address2: | AFFILIATED COMMUNITY MEDICAL CENTERS | ||||||||
City: | LITCHFIELD | ||||||||
State: | MN | ||||||||
PostalCode: | 55355 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3206933233 | ||||||||
FaxNumber: | 3206933290 | ||||||||
Practice Location | |||||||||
Address1: | 520 S. SIBLEY AVE | ||||||||
Address2: | AFFILIATED COMMUNITY MEDICAL CENTERS | ||||||||
City: | LITCHFIELD | ||||||||
State: | MN | ||||||||
PostalCode: | 55355 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3206933233 | ||||||||
FaxNumber: | 3206933290 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/05/2006 | ||||||||
LastUpdateDate: | 04/22/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 36726 | MN | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 2M959ST | 01 |   | BCBS | OTHER | 698827000 | 05 | MN |   | MEDICAID | 01-28554 | 01 |   | MEDICA | OTHER |