1811172901 NPI number — HEALTHPOINT ORIENTAL MEDICINE, LLC

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 1811172901 NPI number — HEALTHPOINT ORIENTAL MEDICINE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHPOINT ORIENTAL MEDICINE, LLC
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:
1811172901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7800 METRO PKWY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55425-1514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-767-4910
Provider Business Mailing Address Fax Number:
952-851-9618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7800 METRO PKWY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55425-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-767-4910
Provider Business Practice Location Address Fax Number:
952-851-9618
Provider Enumeration Date:
01/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WALTERS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
OWNER, EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
952-767-4910

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  1343 , 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: 0000378093 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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