Provider Demographics
NPI:1225214158
Name:PAUL A. HENRIKSEN
Entity Type:Organization
Organization Name:PAUL A. HENRIKSEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENRIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-825-5444
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-0686
Mailing Address - Country:US
Mailing Address - Phone:507-825-5444
Mailing Address - Fax:
Practice Address - Street 1:212 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1634
Practice Address - Country:US
Practice Address - Phone:507-825-5444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0257710001Medicare NSC