Provider Demographics
NPI:1083778708
Name:MEDICAL CARE SERVICES, PA
Entity Type:Organization
Organization Name:MEDICAL CARE SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-706-9630
Mailing Address - Street 1:900 LONG LAKE RD
Mailing Address - Street 2:STE 106
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6414
Mailing Address - Country:US
Mailing Address - Phone:612-706-9630
Mailing Address - Fax:612-706-9617
Practice Address - Street 1:900 LONG LAKE RD
Practice Address - Street 2:STE 106
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6414
Practice Address - Country:US
Practice Address - Phone:612-706-9630
Practice Address - Fax:612-706-9617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC02591Medicare PIN