Basic Information
Provider Information | |||||||||
NPI: | 1538158506 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BACHMANN AND ASSOCIATES, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8669 EAGLE POINT BLVD | ||||||||
Address2: |   | ||||||||
City: | LAKE ELMO | ||||||||
State: | MN | ||||||||
PostalCode: | 550428628 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6513790444 | ||||||||
FaxNumber: | 6513790448 | ||||||||
Practice Location | |||||||||
Address1: | 8669 EAGLE POINT BLVD | ||||||||
Address2: |   | ||||||||
City: | LAKE ELMO | ||||||||
State: | MN | ||||||||
PostalCode: | 550428628 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6513790444 | ||||||||
FaxNumber: | 6513790448 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/20/2005 | ||||||||
LastUpdateDate: | 09/12/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BACHMANN | ||||||||
AuthorizedOfficialFirstName: | MARCUS | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 6513790444 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 1025223-1-MHC | MN | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
ID | Type | State | Issuer | Description | 281294100 | 05 | MN |   | MEDICAID | 335R6BA | 01 | MN | BCBS MN ID# | OTHER | 783903000 | 01 | MN | MAGELLAN/AETNA ID# | OTHER | 241713 | 01 | MN | COMPSYCH ID# | OTHER | 95844 | 01 | MN | HEALTH PARTNERS ID# | OTHER |