1316942824 NPI number — BEECHWOOD, INC.

Table of content: KATHERINE QUINN O'HARA O.D. (NPI 1568905859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316942824 NPI number — BEECHWOOD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEECHWOOD, INC.
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:
1316942824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3901 CHICAGO AVENUE SOUTH
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:
55407-2614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-824-0415
Provider Business Mailing Address Fax Number:
612-825-0789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 CHICAGO AVENUE SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55407-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-824-0415
Provider Business Practice Location Address Fax Number:
612-825-0789
Provider Enumeration Date:
06/21/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
FANNY
Authorized Official Middle Name:
D GAURNIZO
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
612-824-0415

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 325089 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , 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)