1558392852 NPI number — NORTH MEMORIAL HEALTH CARE

Table of content: (NPI 1558392852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558392852 NPI number — NORTH MEMORIAL HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH MEMORIAL 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:
NORTH MEMORIAL HEALTH CLINIC - MAPLE GROVE
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:
1558392852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9855 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE GROVE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55369-4648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-581-2273
Provider Business Mailing Address Fax Number:
763-581-4561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9855 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE GROVE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55369-4648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-581-2273
Provider Business Practice Location Address Fax Number:
763-581-4561
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FROMM
Authorized Official First Name:
DAN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
763-581-4614

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 23575 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01003BA . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 111358 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9804445 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: NM105 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".




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