Provider Demographics
NPI:1104043587
Name:NORTHSTAR CIRCLE OF COMPANIES, INC.
Entity Type:Organization
Organization Name:NORTHSTAR CIRCLE OF COMPANIES, INC.
Other - Org Name:NCC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:651-646-0471
Mailing Address - Street 1:PO BOX 8116
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-0116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2381 CARTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1625
Practice Address - Country:US
Practice Address - Phone:651-646-0471
Practice Address - Fax:651-646-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5331231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12696NOOtherBCBS
002228315002OtherUNITED HEALTHCARE
45-00015OtherMEDICA (SALT LAKE CITY)
MN101102OtherUCARE MINNESOTA
MN634553100Medicaid
MN6396OtherHEALTHPARTNERS
R35358Medicare UPIN
MN101102OtherUCARE MINNESOTA
MN634553100Medicaid