Basic Information
Provider Information | |||||||||
NPI: | 1821232653 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PINDROP HEARING OF SOUTH CENTRAL MINNESOTA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 205 LEWIS ST S | ||||||||
Address2: |   | ||||||||
City: | SHAKOPEE | ||||||||
State: | MN | ||||||||
PostalCode: | 553791459 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9527468688 | ||||||||
FaxNumber: | 9527468687 | ||||||||
Practice Location | |||||||||
Address1: | 205 LEWIS ST S | ||||||||
Address2: |   | ||||||||
City: | SHAKOPEE | ||||||||
State: | MN | ||||||||
PostalCode: | 553791459 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9527468688 | ||||||||
FaxNumber: | 9527468687 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/23/2009 | ||||||||
LastUpdateDate: | 05/24/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WAGNER | ||||||||
AuthorizedOfficialFirstName: | ALLIE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
AuthorizedOfficialTelephone: | 9527468688 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | HIS | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | 2640 | MN | Y |   | Suppliers | Hearing Aid Equipment |   |
No ID Information.