Provider Demographics
NPI:1033474267
Name:PATIENT READINESS INSTUTUTE, INC.
Entity Type:Organization
Organization Name:PATIENT READINESS INSTUTUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-224-9913
Mailing Address - Street 1:5004 1/2 XERXES AVE S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2226
Mailing Address - Country:US
Mailing Address - Phone:612-224-9913
Mailing Address - Fax:612-360-2993
Practice Address - Street 1:5004 1/2 XERXES AVE S
Practice Address - Street 2:SUITE 3
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-2226
Practice Address - Country:US
Practice Address - Phone:612-224-9913
Practice Address - Fax:612-360-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37208207ZB0001X, 207ZC0006X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Single Specialty
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Single Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN387223800Medicaid
MN1114994563OtherTYPE 1 NPI
MNF91240Medicare UPIN