Provider Demographics
NPI: | 1265825228 |
---|---|
Name: | CCRM MINNEAPOLIS, PC |
Entity Type: | Organization |
Organization Name: | CCRM MINNEAPOLIS, PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT AND MEDICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | APRIL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BATCHELLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 701-866-1883 |
Mailing Address - Street 1: | 6565 FRANCE AVE SOUTH |
Mailing Address - Street 2: | SUITE 400A |
Mailing Address - City: | EDINA |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55435 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 952-225-1630 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6565 FRANCE AVE SOUTH |
Practice Address - Street 2: | SUITE 400A |
Practice Address - City: | EDINA |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55435 |
Practice Address - Country: | US |
Practice Address - Phone: | 952-225-1630 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-03-13 |
Last Update Date: | 2015-06-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 261QA0006X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA0006X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Fertility Facility |