Basic Information
| Provider Information | |||||||||
| NPI: | 1386612653 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAPP | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | COMMUNITY MEMORIAL HOSPITAL | ||||||||
| Address2: | 512 SKYLINE BLVD | ||||||||
| City: | CLOQUET | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557201199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188794641 | ||||||||
| FaxNumber: | 2189274130 | ||||||||
| Practice Location | |||||||||
| Address1: | COMMUNITY MEMORIAL HOSPITAL | ||||||||
| Address2: | 512 SKYLINE BLVD | ||||||||
| City: | CLOQUET | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557201199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188794641 | ||||||||
| FaxNumber: | 2189274130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 11/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 42724 | MN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 080015004 | 01 | MN | MEDICARE WPS - MCGREGOR C | OTHER | 080009937 | 01 | MN | MEDICARE WPS - HOSPITAL | OTHER | 080011425 | 01 | MN | MEDICARE WPS - AITKIN CLI | OTHER | 829625100 | 05 | MN | MEDICAID |