Provider Demographics
NPI:1003247396
Name:NORTH MEMORIAL HEALTH CARE
Entity Type:Organization
Organization Name:NORTH MEMORIAL HEALTH CARE
Other - Org Name:NORTH MEMORIAL HEALTH CLINIC - MAPLE GROVE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FROMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-581-4614
Mailing Address - Street 1:9855 HOSPITAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4648
Mailing Address - Country:US
Mailing Address - Phone:763-581-5800
Mailing Address - Fax:763-581-5801
Practice Address - Street 1:9855 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4648
Practice Address - Country:US
Practice Address - Phone:763-581-5800
Practice Address - Fax:763-581-5801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH MEMORIAL HEALTLH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-11
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care