Provider Demographics
NPI:1780654079
Name:SOELTER, TIMOTHY A (PA-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:SOELTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 KINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-2116
Mailing Address - Country:US
Mailing Address - Phone:507-236-5295
Mailing Address - Fax:
Practice Address - Street 1:515 SOUTH MOORE STREET
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013
Practice Address - Country:US
Practice Address - Phone:507-526-3273
Practice Address - Fax:507-526-7724
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9407363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN976445300Medicaid
MNHP30650OtherHEALTH PARTNERS
MN127863OtherUCARE MN
MN388G2SOOtherBLUE CROSS BLUE SHIELD
MN8827OtherAVERA
MN29D91SOOtherBLUE CROSS BLUE SHIELD
MN974311024478OtherPREFERREDONE
MN0113798OtherMEDICA
22906OtherSANFORD HEALTH
MN850268OtherAMERICAS PPO
MN970015283OtherRAILROAD MEDICARE
MN0113798OtherMEDICA
MN970015283Medicare PIN
MN974311024478OtherPREFERREDONE