Provider Demographics
NPI:1104004506
Name:WILLIAM T. SIMONET, MD,PA
Entity Type:Organization
Organization Name:WILLIAM T. SIMONET, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDETTE
Authorized Official - Middle Name:VIOLA
Authorized Official - Last Name:NORDBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-915-8324
Mailing Address - Street 1:6600 FRANCE AVE S
Mailing Address - Street 2:SUITE 605
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1807
Mailing Address - Country:US
Mailing Address - Phone:952-915-8324
Mailing Address - Fax:952-927-5259
Practice Address - Street 1:6600 FRANCE AVE S
Practice Address - Street 2:SUITE 605
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1807
Practice Address - Country:US
Practice Address - Phone:952-915-8324
Practice Address - Fax:952-927-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26306332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN070777500Medicaid
MNC01152OtherMEDICARE ID
A95347Medicare UPIN
MN070777500Medicaid
MN0975830004Medicare NSC