1184655813 NPI number — MINNESOTA LUNG CENTER LTD

Table of content: (NPI 1184655813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184655813 NPI number — MINNESOTA LUNG CENTER LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINNESOTA LUNG CENTER LTD
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:
Provider Other Organization Name Type Code:
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:
1184655813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 E 28TH ST
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55407-1139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-567-7400
Provider Business Mailing Address Fax Number:
952-567-7414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 E 28TH ST
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55407-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-567-7400
Provider Business Practice Location Address Fax Number:
952-567-7414
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAYER
Authorized Official First Name:
DEB
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MGR.
Authorized Official Telephone Number:
952-567-7400

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CP2438 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 410210000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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