NPI |
1679768543 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
ADVANTAGE REHAB INC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
700 CEDAR ST STE 153 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Provider Business Practice Location Address City Name |
ALEXANDRIA |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MN |
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Business Practice Location Address Postal Code |
563081769 |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address Telephone Number |
3202199680 |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
3207591080 |
The State code in the location of the provider
being identified. |
Provider Enumeration Date |
9/12/2007 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
11/23/2011 |
The country code in the location address of the provider being identified. |
Authorized Official Last Name |
SAVAGEAU |
The telephone number associated with the location address of the provider being identified. |
Authorized Official First Name |
MICHAEL |
The first name of the authorized official. |
Authorized Official Title or Position |
OWNER |
The date the provider was assigned a unique identifier (assigned an NPI). |
Authorized Official Telephone Number |
3207669781 |
The date that a record was last updated or changed. |
Healthcare Provider Taxonomy Code 1 |
261QP2000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number 1 |
4769 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
MN |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Credential Text |
PT |
|