Organization Name: | MINNESOTA HEAD AND NECK PAIN CLINIC, PA |
NPI Number: | 1104850155 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LORI J GARDOW (CLINIC ADMINISTRATOR) |
Mailing Address: | 2550 University Ave W Ste 189s St Paul |
State: | MN US |
Postal Code: | 55114 |
Phone Number: | 6513327474 |
Fax Number: | 6513327475 |
NPI Enumeration Date: | 07/10/2006 |
NPI Last Update Date: | 10/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |