Provider Demographics
NPI:1629055272
Name:TUNNELL, JOHN (AUD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:TUNNELL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MEDICAL CENTER DR
Mailing Address - Street 2:PO BOX 800
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4575
Mailing Address - Country:US
Mailing Address - Phone:507-238-8555
Mailing Address - Fax:
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4575
Practice Address - Country:US
Practice Address - Phone:507-238-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-26
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7328231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA551179Medicaid
MN546K3TUMedicaid
MN1216789OtherARAZ
MNMH9041030107OtherPREFERREDONE
MN45-00242OtherMEDICA
MN546K3TUOtherBLUE CROSS
MNA067OtherCHAMPUS
MN56033200Medicaid
MNHP51396OtherHEALTHPARTNERS
MN56033200Medicaid
MN1216789OtherARAZ
MN45-00242OtherMEDICA
MN640000256Medicare ID - Type Unspecified