Provider Demographics
NPI:1265657746
Name:HENNEPIN HEALTHCARE SYSTEM INC
Entity Type:Organization
Organization Name:HENNEPIN HEALTHCARE SYSTEM INC
Other - Org Name:HCMC SHAPIRO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-873-5340
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:PL FINANCE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-3225
Mailing Address - Fax:612-904-4259
Practice Address - Street 1:914 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1204
Practice Address - Country:US
Practice Address - Phone:612-873-2233
Practice Address - Fax:612-873-1941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6411450001332B00000X
MN2629303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN157245800Medicaid
MNC04460Medicare PIN
6411450001Medicare NSC