1063659183 NPI number — CHILDREN'S HEALTH CARE

Table of content: (NPI 1063659183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063659183 NPI number — CHILDREN'S HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S 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:
CHILDREN'S HOSPTIALS AND CLINICS OF MN
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:
1063659183
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:
PO BOX 860123
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55486-0112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-813-7290
Provider Business Mailing Address Fax Number:
612-813-7296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2530 CHICAGO AVE
Provider Second Line Business Practice Location Address:
CSC 225
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404-4289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-813-7290
Provider Business Practice Location Address Fax Number:
612-813-7296
Provider Enumeration Date:
01/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
CHESTEVIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OUTPATIENT PHARMACY MANAGER
Authorized Official Telephone Number:
612-813-7290

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 263375 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2120511 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 137647000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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