1376541243 NPI number — METRO THERAPY SPECIAL CHILDREN'S CLINIC, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376541243 NPI number — METRO THERAPY SPECIAL CHILDREN'S CLINIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO THERAPY SPECIAL CHILDREN'S CLINIC, 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:
1376541243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5155 E RIVER RD
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
FRIDLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55421-1025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-572-2519
Provider Business Mailing Address Fax Number:
763-572-2616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5155 E RIVER RD
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
FRIDLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55421-1025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-572-2519
Provider Business Practice Location Address Fax Number:
763-572-2616
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CHAPUT
Authorized Official First Name:
AUDREY
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
763-572-2519

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 23738 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2G055CH . This is a "BC/BS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5G0765A . This is a "BC/BS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 120622 . This is a "U-CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01016321 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 156755100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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