Organization Name: | NORTH MEMORIAL HEALTH CARE |
NPI Number: | 1003247396 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES KEVIN CROSTON (CEO) |
Mailing Address: | 12000 Elm Creek Blvd N Suite 130 Maple Grove |
State: | MN US |
Postal Code: | 553697073 |
Phone Number: | 7635815800 |
Fax Number: | 7635815801 |
NPI Enumeration Date: | 12/11/2013 |
NPI Last Update Date: | 12/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |