P.O. Box 211395 Eagan, MN 55121. Reminder: All claims should be submitted electronically, unless required documentation is needed to process claim. Find our EDI vendor information through one of the following: 1. Office Ally Payer ID: HPSJ1 866-575-4120. 2. Change Healthcare (EMDEON) Payer ID: 68035 877-469-3263Mail: P.O. Box 21164, Eagan, MN 55121 Email: [email protected] Fax: 1-888-240-7243 OON providers should submit requests to: Mail: P.O. Box 21672, Eagan, MN 55121 Email: [email protected] Fax: 1-732-412-9706 Y0129_FX070Q Patient Information Patient Name: Member ID: CP AttachmentsP.O. Box 21146 Eagan, MN 55121. Members - Mail Forms and Payments. Direct Premium Payments. Excellus Health Plan P.O. Box 5267 Binghamton, NY 13902-5267. Group ...Eagan Athletic Association (EAA) is a 60+ year old community led non-profit organization dedicated to the development of the community's young people through athletics. ... PO Box 211202 Eagan, MN 55121. This website is powered by SportsEngine's Sports Relationship Management (SRM) software, but is owned by and subject to the Eagan Athletic ...P.O. Box 211651 Eagan, MN 55121 FedEx & UPS Shipping Address. 960 Blue Gentian Road Eagan, MN 55121 Corporate Address. 200 W Adams St., Suite 500 Chicago, IL 60606 This address does not receive mail. If you need to mail us documents related to your benefit plan, please use the mailing address above.P.O. Box 211184 Eagan, MN 55121 Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield — independent licensees of the Blue Cross and Blue Shield Association. 17398 2014-1962-9/16Whatever questions or issues you may have, here are some ways to get in touch with us. 1.800.241.1439 1.800.241.1439. Bankers Fidelity Life Insurance CompanyP.O. Box 211184 Eagan, MN 55121 TO BE COMPLETED BY PATIENT PATIENT INFORMATION: 1. PATIENT'S NAME (LAST) (FIRST) (MIDDLEINITIAL) 2. PATIENT'S ADDRESS (STREET) (CITY) (STATE) (ZIP CODE) ... Polish UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-800-275-2583.• If you submit paper claims, send to the new PO Box: Claims mailing address: Premera Blue Cross Blue Shield of AK P.O. Box 21762 Eagan, MN 55121 . 4. Check the status of a claim: • Electronic claim: You can continue to check the status of a claim electronically as you do today. Wait 48 hours before checking or running claim status.P.O. Box 211184 Eagan, MN 55121 OUT-OF-NETWORK CLAIM FORM (see reverse side for instructions) Cross 1519 D 2/07 ATTACH ® RECEIPTS HERE MEMBER/PATIENT MEMBER’S NAME (First, Middle, Last) IDENTIFICATION NUMBER PRESENT ADDRESS STREET D NEW ADDRESS CITY STATE ZIP CODE PATIENT’S NAME (First, Middle, Last) RELATIONSHIP OF PATIENT TO MEMBERPO Box 211116 Eagan, MN 55121. Dental, Vision, and Hearing Claims. Phone. 833-653-6338. Fax. 833-517-1852. Email. [email protected]. Mailing Address. Careington Benefit Solutions PO Box 21681 Eagan, MN 55121. FedEX/UPS. Mailing Address. LifeShield National Insurance Co 5500 N. Western Ave, Suite 200PO Box 211286 Eagan; MN 55121 (847) 298-6000 (847) 298-5802; [email protected] 475 1033149844; 475 1033149844; Northwestern Med Phys Network West and NW Suburbs Claims Inquiry; Client Services 1639 N Alpine Rd; Suite 401 Rockford; IL 61107 (888) 322-1608 800-747-2264; [email protected];Fill Po Box 211184 Eagan Mn 55121, Edit online. Sign, fax and printable from PC, iPad, tablet or mobile with pdfFiller Instantly. Try Now!P.O. Box 211651 Eagan, MN 55121 FedEx & UPS Shipping Address. 960 Blue Gentian Road Eagan, MN 55121 Corporate Address. 200 W Adams St., Suite 500 Chicago, IL 60606 This address does not receive mail. If you need to mail us documents related to your benefit plan, please use the mailing address above.• If you submit paper claims, send to the new PO Box: Claims mailing address: Premera Blue Cross Blue Shield of AK P.O. Box 21762 Eagan, MN 55121 . 4. Check the status of a claim: • Electronic claim: You can continue to check the status of a claim electronically as you do today. Wait 48 hours before checking or running claim status.P.O. Box 211747 Eagan, MN 55121 Standard Life & Accident Insurance Company P.O. Box 211748 Eagan, MN 55121 Claims Payment: If you send documentation showing you have paid the provider along with the EOBs and the provider statement, we will pay the benefit to you. Claims info can be sent to MWG Administrators via: ...Post a Comment. Po Box 211282 Eagan Mn. Box 211184 mn 55121 blue cross® independence qca traditional blue cross® blue ®shield 54704 qce 54704 12x26 claims receipt center p.o. Group benefit services claim department p.o. American School Of Nursing And Allied Health Reviews from weightlossmaintain.blogspot.com.Insert images to visualize your P o box 21184 eagan mn 55121. Replace the original text with the one corresponding with your requirements. Add comments or sticky notes to communicate with others on the updates. Drop extra fillable areas and assign them to particular people. Protect the template with watermarks, add dates, and bates numbers.P.O. Box 211595 Eagan, MN 55121. Providers can now submit via fax to 608-327-6332 instead of mailing. For new and corrected claims, please do not include a fax cover sheet. You may fax just the claim form or just the Corrected Claim Form and normal supporting documents (PRA). ... P.O. Box 2906 Milwaukee, WI 53201-2906 Phone: (855) 453-5287 for ...P.O. Box 21146 Eagan, MN 55121. Risk Adjustment. Contact our team of certified risk adjustment coders who can assist with documentation and coding tips specific to your practice. Contact By: [email protected]. HEDIS Quality.po box 211223 eagan, mn 55121. po box 211223 eagan, mn 55121. November 9, 2022; facecheck league of legends; cheap flight finder to anywhere; Here are some ways to get in touch. 39 0 obj ...P.O. Box 21548 • Eagan, MN 55121 • Phone: 888-803-0081 • Fax: 806-783-9991 • Customer Service Email: [email protected]: CLAIM FOR HEALTH CARE BENEFITS: Name of Other Carrier Address: of Other Carrier (City) (State) (Zip) Effective Date of Other Coverage:P.O. Box 21545 Eagan, MN 55121 Note: Submit AmeriHealth Administrators new claims or adjustment requests directly to AmeriHealth ... P.O. Box 41820 Philadelphia, PA 19101 Inpatient Facility Appeals P.O. Box 13985 Philadelphia, PA 19101-3985 Provider Claims Appeals - NJ HMO/PPOP.O. Box 211184 Eagan, MN 55121 Valid and registeredQ3C NPI is required. Electronic (837I) Loop 2010AA NM108 = XX NM109 = NPI # Paper (UB-04) NPI # - Box 56 Q3B AmeriHealth PA - ERISA HMO ... P.O. Box 21545 Eagan, MN 55121 *For use only by those who use Emdeon as their clearinghouse. Clearinghouses may update submission rules.p.o. box 211184 eagan, mn 55121 to be completed by patient patient information: 1. patient’s name (last) (first) (middleinitial) 2. patient’s address (street) (city) (state) (zip code) 3. member identification number 4. patient’s phone number ( ) area code 5. 6.patient’s birth date patient’ssex male female 7.P.O. Box 211184 Eagan, MN 55121 Contact your insurance provider directly if you haven't received a reimbursement check in the mail after 3-4 weeks. Please note: If your claim is denied, you should go through your insurance provider's appeal process. Should you want to escalate the denial, you can contact HHS at Contraception_Complaints@cms ...P.O. Box 211681 Eagan, MN 55121 For pharmacy support: Contact MedImpact Provider phone line: 844‐401‐2055 Fax: 858‐790‐7100 If you require additional communication or to send form and documents, you may: • Fax to Centivo Support: 716‐219‐1946Impacted cards issued on or after November 26, 2014 display the new medical claims submission address. The new medical claims submission address for under and over 65 commercial products (except for the excluded products noted above) is: PO Box 211457 Eagan, MN 55121. CBC will not mass reissue new member ID cards due to the address change ...P.O. Box 211184 Eagan, MN 55121 PPO PROGRAM OUT-OF-NETWORK CLAIM FORM (see reverse side for instructions) 09517 (03/09) H S T MEMBER'S NAME (First, Middle, Last) IDENTIFICATION NUMBER GROUP NUMBER PRESENT ADDRESS STREET D NEW ADDRESS CITY STATE ZIP CODE NAME (First ...P.O. Box 21522 | Eagan, MN 55121-0522. AFFILIATIONS AND RECOGNITION ©2024 Dominion National Dominion National is the brand name for the Dominion group of companies. Dental plans are underwritten by Dominion Dental Services, Inc. (DDSI). Dominion Dental Services USA, Inc. (DDSUSA) is a licensed administrator of dental and …Claims Submissions. Two ways to submit claims: EDI-SA001; Mail: Signature Advantage, PO Box 21063 Eagan, MN 55121HealthEZ: PO Box 211186, Eagan, MN 55121 PRIMARY MEDICAL NETWORK: America's PPO AmericasPPO.com TRAVEL MEDICAL NETWORK: PI-ICS Out of Area 800-678-7427, MultiPlan.comlHealthEZ PHARMACY: WellDyne 888-479-2000, WellDyne.com Out Of Area welldyne Administered by: health Policy Holder: Group: Subscriber:P.O. Box 211184 Eagan, MN 55121 Valid and registered NPI is required. Electronic (837I) Loop 2010AA NM108 = XX NM109 = NPI # Paper (UB-04) NPI # – Box 56 Q1P AmeriHealth NJ – POS, POS NG Q3A AmeriHealth PA – ERISA POS Q3B AmeriHealth PA – ERISA HMO Q3C AmeriHealth PA – HMO and Self-Funded HMO Q3P AmeriHealth PA – POS and Self-Funded POSP.O. Box 211322 Eagan, MN 55121 Please remember that Medicaid is secondary and will generally not pay more than the Medicaid allowable. Therefore, if Medicare, or a Medicare Advantage Plan has paid greater than the Medicaid allowable, then no secondary payment is due to a provider, pursuant to Florida Administrative Code 59G-1.052(8)(b)1.Add pdfFiller Google Chrome Extension to your web browser to start editing po box 211034 eagan mn 55121 form and other documents directly from a Google search page. The service allows you to make changes in your documents when viewing them in Chrome. Create fillable documents and edit existing PDFs from any internet-connected device with pdfFiller.Please contact GPS for filing assistance at 888-301-0747. To file dental claims, use EDI#37086 or mail to GPS PO Box 21424 Eagan MN 55121. We do not accept paper claims for Medicare Supplement plan claims. Claims filed with Medicare will electronically transmit to Pekin Life Insurance Company for our Medicare Supplement insureds.P.O. Box 211651 Eagan, MN 55121 E [email protected] Group Number Employer Location (if applicable) Employee UID or SSN Flex Plan Year Address City State Zip Dental/Vision Provider's Signature (or attach receipt)-----I have not and will not itemize and deduct nor claim credit for these expenses on my income tax returns.P.O. Box 21146 Eagan, MN 55121. Our Premium Payment Address: Excellus BlueCross BlueShield - Group P.O. Box 5266 Binghamton, NY 13902-5266. Our Corporate Street Address: In the Central New York and Southern Tier Regions: Excellus BlueCross BlueShield 333 Butternut Drive Syracuse, NY 13214-1803.P.O. Box 211592 Eagan, MN 55121-2892 Payer ID 06541 CountyCare Provider Quick Reference Guide January 2021 Page 1 of 2 Provider Services CountyCare Website Visit for documents, forms, important health plan information, and provider and member resources. https://www.countycare.comPO Box 211547 Eagan, MN 55121-2747 GBS EDI #80241 See your Plan Document for the complete list of benefits, limits, and exclusions. This card is for identification only. It is not a guarantee of eligibility. See your Plan Document for the complete list of benefits, limits, and exclusions. This card is for identification only.41385932F. Contact Us About The Company Profile For Group Management Services, Inc. SIMPEO, LLC. WASHINGTON FOREIGN LIMITED-LIABILITY COMPANY. WRITE REVIEW. Address: Po Box 21933. Eagan, MN 55121. Address Types:• Mail to PO Box 21531 Eagan, MN 55121 • Fax to 877-877-0078 Contact Customer Service 800-654-9106. CLAIM INFORMATION NEEDED BY PRODUCT. List from the pharmacy. PREFERRED. Physician’s Home Health. Certification Form. Standard Claim Form. or. Claim receipt that shows details. of the prescription (policyholder. name, drug …PO Box 21931 Eagan, MN 55121. Providers are highly encouraged to use a trackable mailing method such as USPS Priority Mail when sending documents to this address. This will allow for the package to be tracked and provide proof of timely claim submission. Acceptance of PaymentPO Box 21146 Eagan, MN 55121-0146 ExcellusBCBS.com . FORM - MXCNY. MEDICARE ELIGIBILITY FORM . Group Number: Group Name: Subscriber ID Number: Member Name: CHECK ONE STATEMENT THAT REPRESENTS YOUR TOTAL EMPLOYEE POPULATION: _____Employs 20 or less _____Employs 20 or moreBilling Address: P.O. Box 21036 Eagan, MN 55121 Plan Products: Commercial Self-Funded, TriWest CCN Co-payments: Refer to Member ID Card Benefit Questions: Refer to Member ID Card Referral / Precertification: Refer to Member ID Card Timely Filing: 120 Days from Date of Service Timely Payment: 30 Days from Receipt of …PO Box 21455 Eagan, MN 55121 Electronic Submissions: Use Amida Care Submitter ID # 79966. How do I check the status of a claim? Call Provider Services at 1-800-556-0674. How can I appeal a claim denial? You have 60 days from the date of a claim denial to submit an appeal. To file an appeal, mail the Statement of Remittance (SOR) denial that you ...P.O. Box 21185 Eagan, MN 55121 Customer Service Toll free: 1-800-461-0430 Worldwide: 317-818-2867 Collect: 317-818-2809 Claims Fax: 317-575-6467 Email: [email protected]. 303 Congressional Blvd. Carmel, Indiana 46032. Careers. Contact Us. Connect. Our Markets. Consumer Insurance; Government Solutions;PO Box 211184 Eagan, MN 55121 You must submit your claim to us within 12 months of the date you received the service, item,or drug. In order to process this reimbursement, a copy of your paid claim receipt must be attached to this form. Please contact the Member Help Team at 1-800-645-3965 for Keystone 65 HMO members, or 1-888-Call us: 1-800-338-6833 (TTY 711) Devoted Guides are here: 8am to 8pm, 7 days a week (October to March) 8am to 8pm, Monday to Friday, and 8am to 5pm, Saturday (April to September) Text us: 866-85. Ask a question about your plan, or just say "Hello!" to get started! Digital Guides are here: 8am to 8pm Eastern time, Monday to Friday.Date received: Please mail this form, along with your receipt to: Claims Receipt Center PO Box 211184 Eagan, MN 55121. Personal Choice 65 ofers PPO plans with a Medicare contract. Enrollment in Personal Choice 65 Medicare Advantage plans depends on contract renewal. Benefits underwritten by QCC Insurance Company, a subsidiary of Independence ...P,O, Box 211184 Eagan, MN 55121 (see reverse side for instructions) II. III. z o ~ 8 1Il ffi ~•• IV, z oi ~ MEMBER'S NAME (First, Middle, Last) IDENTIFICATION NUMBER GROUP NUMBER PRESENT ADDRESS STREET D NEW ADDRESS CITY STATE ZIP CODE • • PATIENTS NAME (First, Middle, Last) RELATIONSHIP OF PATIENTTO MEMBER SEX BIRTiHDATE DSELF DSPOUSE ...P.O. Box 64560 St. Paul, MN 55164-0560. Media contacts: For corporate public relations inquiries, please contact [email protected] or a member of our Public Relations team. ... Eagan MN 55121-1627. See map. RiverPark II. 1800 Yankee Doodle Road Eagan, MN 55121-1644. See map.Outer County Claims – Lehigh, Lancaster, Northampton, and Berks County Claims Receipt Center P.O. Box 211184 Eagan, MN 55121. Claims submission information for providers.P.O. Box 211681 Eagan, MN 55121 For pharmacy support: Contact MedImpact Provider phone line: 844‐401‐2055 Fax: 858‐790‐7100 If you require additional communication or to send form and documents, you may: • Fax to Centivo Support: 716‐219‐1946Choice 65 PPO, P.O. Box 7799, Philadelphia, PA 19101-7799. Submit paper medical claims to: Claims Receipt Center P.O. Box 211184 Eagan, MN 55121 Submit prescription claims to Prescription Drug Claims P.O. Box 650287 Dallas, TX 75265-0287. Visit www.ibxmedicare.com for benefit information Shipper ID: 00000000 Insert #1 Insert #2NPI # – Box 33A Blue Cross® Independence QMO MedigapFreedom 54704 54704 Claims Receipt Center P.O. Box 211184 Eagan, MN 55121 Blue Shield® Highmark QCA QCC Traditional Blue Cross® Blue Shield® Concurrent Major Medical 54771 54771 Highmark Blue Shield P.O. Box 890062 Camp Hill, PA 17089-0062 QCE Security 65®, 65 Special, and ...PO Box 211435 Eagan, MN 55121 Or fax this form to: 952-992-3024 ... Civil Rights Coordinator, Mail Route CP250, PO Box 9310, Minneapolis, MN 55443-9310, 952-992-3422 (phone/fax), TTY 711, [email protected]. You can file a grievance in person or by mail, fax, or email. You may also contact the Civil Rights Coordinator if youP.O. Box 21660, Eagan, MN 55121-0660 Fax: 402-496-8199 How to file a claim When you visit your provider, they’ll likely offer to file your claim for you. They might also ask that you pay your share of the cost at the time of your appointment. Either way, if you want them to file your claim, you’ll need to show them your Medico insurance card.P.O. Box 211468 Eagan, MN 55121 • Filing deadline is 90 days from the date of service. • Professional services (CPT) must be submitted on a CMS-1500 claim form. • Inpatient services must be submitted on a UB-04 claim form. • Handwritten submissions will be rejected. • Do not use labels, stickers, or stamps on the claim form.P.O. Box 21660 Eagan, MN 55121-0660 Fax: 402-496-8199 We're here for you: If you have any questions, please call us at 800-228-6080, Monday - Friday, 7:30 a.m. to 5 p.m. Central time. Our secure customer portal and Wellabe: Be Well mobile app provide 24/7 access to your plan. You can view planP.O. Box 211184 Eagan, MN 55121 ATTACH RECEIPTS HERE I. PATIENT'S NAME (First, Middle, Last) IDENTIFICATION NUMBER SEX BIRTH DATE ... Polish UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-800-275-2583. Italian: ATTENZIONE: Se lei parla italiano, sonoPO Box 211547 Eagan, MN 55121-2747 GBS EDI #80241 See your Plan Document for the complete list of benefits, limits, and exclusions. This card is for identification only. It is not a guarantee of eligibility. See your Plan Document for the complete list of benefits, limits, and exclusions. This card is for identification only.Dental Insurance Information. un Life Portal Link. Dental Coverage provided by Aflac Financial ended July 31, 2023 Customer Care Center: 1-855-819-1873PO Box 21545|Eagan, MN 55121 Fax ##215-784-0672. Approval Process. After the request is submitted, the service or drug is reviewed to determine if it: is covered by the health plan, and; meets the health plan's definition of "medically necessary." The prior authorization is then completed, and the results are sent to the provider.We would like to show you a description here but the site won’t allow us.As of June 30th, there will no longer be access to the secure member portal. If you have claims or plan specific questions please call 844.388.8268.Important contact information. AmeriHealth Administrators. Provider Services (Direct all inquiries or issues) directly to AmeriHealth Administrators. 1-800-841-5328. Email: [email protected]. Anti-Fraud and Corporate Compliance. Hotline.PO Box 211438 Eagan, MN 55121; Or fax to 608-276-9119 Attention: New claims; For other claims correspondence use the Claims Resubmission Form (located below) and submit it via secure file upload by clicking on the button below. Secure File Upload. Claim Resubmission Request Form.Important contact information. AmeriHealth Administrators. Provider Services (Direct all inquiries or issues) directly to AmeriHealth Administrators. 1-800-841-5328. Email: [email protected]. Anti-Fraud and Corporate Compliance. Hotline.Amerihealth Caritas of Michigan Address: PO Box 211184 Eagan, MN 55121-5512 Telephone: 888-667-0318The completed form should be sent to INDECS - A Homestead Company using any of the below methods within 30 days of when services were provided. SUBMIT YOUR CLAIM BY: Mail: INDECS Claims Dept, PO Box 21082, Eagan, MN 55121-0082 Fax: 201-460-3204. Online: Member Portal.p.o. box 211517 eagan, mn 55121-2717 if sending by facsimile, fax to: 915-532-0159 employee name employer ssn address phone city state zip email claim is for: employee spouse child claimant's date of birth if this claim is for a child over 19 years of age, is the child a full-time student? yes no if yes, school nameQuick MEDICAL/BEHAVIORAL HEALTH APPEALS • Utilization Management Appeals to: Amida Care Appeals Dept., 2170 W. State Rd 434 Suite 450 Longwood, FL 32779 • Amida Care Claims Appeals to: Attn: Claims Appeals P.O. Box 21455, Eagan, MN, 55121 • Behavioral Health Appeals to: Beacon Health Strategies, Amida Care Health Plan Claims Department, ...P.O. Box 21406 Eagan, MN 55121 I Address Change: _____ _ IMPORTANT: EVERY ITEM MUST BE CHECKED OR ANSWERED BEFORE CLAIM CAN BE PROCESSED GIVE THE FOLLOWING INFORMATION ABOUT PATIENT 1. Claim is made for: 2. Patient's Name 3. Date of Birth 4. Sex 0 Husband 0 Self OM OF 0 Wife 0 Unmarried 0 Other Son/Daughter 5. Full Time Student AttendingPO Box 21051 Eagan, MN 55121-0051 Electronic pay ID: 12422. Medica Behavioral Health claims should be submitted to: Medica PO Box 30757 Salt Lake City, UT 84130 Electronic pay ID: 87726. Medica Chiropractic claims should be submitted to: Medica PO Box 212 Minneapolis, MN 55440-0212 Electronic pay ID: 41161Mar 28, 2022 · How Do I Submit a Claim For Reimbursement? - Lucent Health. Let's Talk. Previous Next. Complete a Health Claim Reimbursement Form. Submit the completed form with a copy of a superbill from your provider and a receipt of your payment to: email: [email protected]. or. fax: 615-255-6654, attn: mailroom.PO Box 211008, Eagan, MN 55121 Fair Processing Notice The GBG Group includes insurance companies, brokering and management companies, as well as assistance and operations companies. We respect your privacy and we are all committed to protecting your personal information.P.O. Box 211184 Eagan, MN 55121 Valid and registered NPI is, Date received: Please mail this form, along with your receipt to: Claims Receipt Center PO B, About. Better Health. Better Health is located at 2020 Silver Bell Rd in Eagan, Minnesota 55122. Better Health c, Mercy Benefit Administrators. Mercy is changing the healthcare experience fo, You can file a grievance in the following ways: In person or, If you submit paper claims, continue to use the industry standard claims form and mail it to the new mailing, American Diabetes Association 2451 Crystal Drive, Suite 900 Arlington, VA 2220, HealthEZ: PO Box 211186, Eagan, MN 55121 PRIMARY MEDICAL NET, P.O. Box 21146 Eagan, MN 55121. Our Corporate Street Addres, P.O. Box 211184 Eagan, MN 55121 Valid and registered NPI is , If you are looking for Po Box 211282 Eagan Mn you've a, P.O. Box 211747 Eagan, MN 55121 Standard Life & Accident In, Mail disputes to: Provider Disputes, PO Box 211624, Eagan MN 5, P.O. Box 21913 Eagan, MN 55121 John Muir Physician Network: Office Al, P.O. Box 21522 | Eagan, MN 55121-0522. AFFILIATIONS AND RECOGNITIO, P.O. Box 21013. Eagan, MN 55121. 610.933.4122 (Fax). 610.933.0800 (, P.O. Box 211184 Eagan, MN 55121 PPO PROGRAM OUT-OF-NETWORK CLAIM F, P.O. Box 211184 Eagan, MN 55121 Valid and registered NPI is.