Provider Demographics
NPI:1275528671
Name:MULTICARE ASSOCIATES OF THE TWIN CITIES,PA
Entity Type:Organization
Organization Name:MULTICARE ASSOCIATES OF THE TWIN CITIES,PA
Other - Org Name:FRIDLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-785-7710
Mailing Address - Street 1:480 OSBORNE RD NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2773
Mailing Address - Country:US
Mailing Address - Phone:763-785-4500
Mailing Address - Fax:763-785-3314
Practice Address - Street 1:480 OSBORNE RD NE
Practice Address - Street 2:SUITE 100
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2773
Practice Address - Country:US
Practice Address - Phone:763-785-4500
Practice Address - Fax:763-785-3314
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MULTICARE ASSOCIATES OF THE TWIN CITIES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-13
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35207Q00000X, 207R00000X, 207V00000X, 208000000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty