1174633440 NPI number — ERIN VAN WINKLE GRIMM MD

Table of content: ERIN VAN WINKLE GRIMM MD (NPI 1174633440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174633440 NPI number — ERIN VAN WINKLE GRIMM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIMM
Provider First Name:
ERIN
Provider Middle Name:
VAN WINKLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRIMM
Provider Other First Name:
ERIN
Provider Other Middle Name:
ELYSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174633440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 10TH AVE S STE 2200
Provider Second Line Business Mailing Address:
HOSPITAL PATHOLOGY ASSOC
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55407-1311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-767-8370
Provider Business Mailing Address Fax Number:
612-767-8376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 10TH AVE S STE 2200
Provider Second Line Business Practice Location Address:
HOSPITAL PATHOLOGY ASSOC
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55407-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-767-8370
Provider Business Practice Location Address Fax Number:
612-767-8376
Provider Enumeration Date:
08/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  53901 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)