1548353691 NPI number — CHILDRENS HEALTH CARE

Table of content: (NPI 1548353691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548353691 NPI number — CHILDRENS HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDRENS HEALTH CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHILDRENS HOSPITALS AND CLINICS OF MINNESOTA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548353691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 LINCOLN DRIVE, CBC-2-REV/PE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55436-1611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-992-5398
Provider Business Mailing Address Fax Number:
952-992-6917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 NORTH SMITH AVENUE
Provider Second Line Business Practice Location Address:
CHILDRENS HOSPITALS AND CLINICS PATHOLOGY STPL
Provider Business Practice Location Address City Name:
ST PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-220-6650
Provider Business Practice Location Address Fax Number:
651-220-5280
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GORELICK
Authorized Official First Name:
MARC
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
612-813-8031

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  331019 , 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)

  • Identifier: 141847500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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