| Organization Name: | GILLETTE CHILDREN'S SPECIALTY HEALTHCARE |
| NPI Number: | 1225119175 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LADONNA ROSS (MANAGER-CENTRAL BUSINESS OFFICE) |
| Mailing Address: | 200 East University Ave St. Paul |
| State: | MN US |
| Postal Code: | 55101 |
| Phone Number: | 6512912848 |
| Fax Number: | 6513252250 |
| NPI Enumeration Date: | 10/18/2006 |
| NPI Last Update Date: | 06/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |