=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255505079
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGLE HANDS SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2008
-----------------------------------------------------
Last Update Date | 04/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13797 GOLDENEYE WAY
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55374-4901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-439-8119
-----------------------------------------------------
Fax | 763-657-1267
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13797 GOLDENEYE WAY
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55374-4901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-439-8119
-----------------------------------------------------
Fax | 763-657-1267
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS ESTELLA KARIN GARDER
-----------------------------------------------------
Credential | OTHER
-----------------------------------------------------
Telephone | 763-439-8119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------