Provider Demographics
NPI:1073867263
Name:HANS BJELLUM MD PC
Entity Type:Organization
Organization Name:HANS BJELLUM MD PC
Other - Org Name:7 DAY WALK IN CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HANS
Authorized Official - Middle Name:
Authorized Official - Last Name:BJELLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-232-6211
Mailing Address - Street 1:6501 CITY WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3248
Mailing Address - Country:US
Mailing Address - Phone:952-653-2525
Mailing Address - Fax:
Practice Address - Street 1:1100 19TH AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-5906
Practice Address - Country:US
Practice Address - Phone:701-232-6211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANS BJELLUM MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site