Active NPI
Phillip Buganski, LAT, OTC
- Other Technician
- Vadnais Heights, MN
National Provider Identifier
1174110043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 2389
- Practice address
- 3580 Arcade St
Vadnais Heights, MN 55127-7135 - Phone
- (651) 968-5200
- Fax
- (651) 730-3750
- NPI assigned
- Dec 28, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 2389 | MN | Primary |
Addresses
Primary practice location
3580 Arcade St
Vadnais Heights, MN 55127-7135
Mailing address
4952 Emmit Dr N Unit 2
Hugo, MN 55038-8505
Phone (763) 355-2874
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2389 | Other | MN | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2389 | MN | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609113600000",
"number": "1174110043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4952 EMMIT DR N UNIT 2",
"city": "HUGO",
"state": "MN",
"postal_code": "550388505",
"telephone_number": "763-355-2874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3580 ARCADE ST",
"city": "VADNAIS HEIGHTS",
"state": "MN",
"postal_code": "551277135",
"telephone_number": "651-968-5200",
"fax_number": "651-730-3750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUGANSKI",
"first_name": "PHILLIP",
"credential": "LAT, OTC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-28",
"last_updated": "2020-12-28",
"certification_date": "2020-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "MN",
"license": "2389",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "2389",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vadnais Heights, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.