NPIMap

Organization Active NPI

BST Morris LLC

  • Physical Therapist
  • Morris, MN
National Provider Identifier
1124216536
Registry record updated Mar 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
BST MORRIS LLC
Practice address
616 Atlantic Ave
BST Morris LLC
Morris, MN 56267-1380
Phone
(320) 585-5395
Fax
(320) 839-4196
NPI assigned
Oct 10, 2007
Last updated
Mar 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Wade D Vandover, PT
Title
President
Phone
(320) 839-4152

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X NU
Physical Therapist 225100000X NU Primary
Physical Therapy Assistant 225200000X NU
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

616 Atlantic Ave
BST Morris LLC
Morris, MN 56267-1380

Mailing address

309 Washington Ave
BST Morris LLC
Ortonville, MN 56278-1357
Phone (320) 839-4271

Other identifiers 1

IdentifierTypeStateIssuer
842967700MedicaidMN

National Provider Directory

National Provider Directory

Locations

309 Washington Ave
Ortonville, MN 56278
Phone (320) 839-4090

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394409600000",
    "number": "1124216536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 WASHINGTON AVE",
            "address_2": "BST MORRIS LLC",
            "city": "ORTONVILLE",
            "state": "MN",
            "postal_code": "562781357",
            "telephone_number": "320-839-4271",
            "fax_number": "320-839-4196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 ATLANTIC AVE",
            "address_2": "BST MORRIS LLC",
            "city": "MORRIS",
            "state": "MN",
            "postal_code": "562671380",
            "telephone_number": "320-585-5395",
            "fax_number": "320-839-4196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BST MORRIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-10",
        "last_updated": "2014-03-10",
        "status": "A",
        "authorized_official_last_name": "VANDOVER",
        "authorized_official_first_name": "WADE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "320-839-4152",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "842967700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morris, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.