1497835656 NPI number — MENTAL HEALTH SYSTEMS PC

Table of content: (NPI 1497835656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497835656 NPI number — MENTAL HEALTH SYSTEMS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTAL HEALTH SYSTEMS PC
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:
1497835656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7200 FRANCE AVE
Provider Second Line Business Mailing Address:
STE 327
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-4310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-835-2002
Provider Business Mailing Address Fax Number:
952-835-9889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 FRANCE AVE
Provider Second Line Business Practice Location Address:
STE 327
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-4310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-835-2002
Provider Business Practice Location Address Fax Number:
952-835-9889
Provider Enumeration Date:
10/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARLSON
Authorized Official First Name:
MARK
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
952-835-2002

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 58068200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8448303 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103953 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1034301 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 92012 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 124R9ME . This is a "BCBS" identifier . This identifiers is of the category "OTHER".