Provider Demographics
NPI:1043204233
Name:MINNEAPOLIS RADIATION ONCOLOGY PA
Entity Type:Organization
Organization Name:MINNEAPOLIS RADIATION ONCOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:PFOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-920-4915
Mailing Address - Street 1:7401 METRO BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3086
Mailing Address - Country:US
Mailing Address - Phone:952-920-4915
Mailing Address - Fax:952-915-6091
Practice Address - Street 1:7401 METRO BLVD STE 210
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439
Practice Address - Country:US
Practice Address - Phone:952-920-4915
Practice Address - Fax:952-915-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9512085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24-0004OtherMEDICA PRIMARY
MN11640MIOtherBLUE CROSS/BLUE SHIELD
MN102376OtherUCARE
WI32721200Medicaid
MN805212300Medicaid
MN805212300Medicaid
MNCY0140Medicare ID - Type UnspecifiedRAILROAD