Provider Demographics
NPI:1093745382
Name:VINYCH, JOHN V (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:VINYCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7132207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND677372OtherAMERICA'S PPO/ARAZ #
NDHP38591OtherHEALTHPARTNERS #
NDND200072OtherLHS #
ND142076OtherUCARE #
ND2000734OtherMEDICA #
ND21246OtherSIOUX VALLEY #
ND8T196VIOtherMNBS #
ND843053500Medicaid
ND12690OtherNDBS #
NDDA9011015600OtherPREFERRED ONE #
ND2000733OtherMEDICA #
ND18260Medicaid
ND677372OtherAMERICA'S PPO/ARAZ #
ND21246OtherSIOUX VALLEY #
ND8T196VIOtherMNBS #
ND050034930Medicare ID - Type UnspecifiedRR MEDICARE #