1730586819 NPI number — UNIVERSITY OF MINNESOTA PHYSICIANS

Table of content: (NPI 1730586819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730586819 NPI number — UNIVERSITY OF MINNESOTA PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF MINNESOTA PHYSICIANS
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:
1730586819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6300 SHINGLE CREEK PARKWAY
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
BROOKLYN CENTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55430-2127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-782-6400
Provider Business Mailing Address Fax Number:
763-782-9558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
814 SOUTH 3RD ST
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:
55415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-888-9792
Provider Business Practice Location Address Fax Number:
612-888-9762
Provider Enumeration Date:
12/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
MARY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
612-884-0802

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C02390 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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