1528361573 NPI number — HENNEPIN HEALTHCARE SYSTEM, INC

Table of content: (NPI 1528361573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528361573 NPI number — HENNEPIN HEALTHCARE SYSTEM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENNEPIN HEALTHCARE SYSTEM, 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:
6
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:
1528361573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 PARK AVE
Provider Second Line Business Mailing Address:
P1-FINANCE
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55415-1623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-873-3000
Provider Business Mailing Address Fax Number:
612-904-4259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S 6TH ST
Provider Second Line Business Practice Location Address:
GOVERNMENT CENTER-A 120
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55487-0070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-348-4628
Provider Business Practice Location Address Fax Number:
612-596-9984
Provider Enumeration Date:
12/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLINGS
Authorized Official First Name:
DERRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
C.F.O
Authorized Official Telephone Number:
612-873-5340

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  367142 , 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)

  • Identifier: 157245800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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