Provider Demographics
NPI:1275917312
Name:UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER, INC.
Other - Org Name:UNIVERSITY OF MINNESOTA HEALTH BREAST CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-884-0802
Mailing Address - Street 1:720 WASHINGTON AVE SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2924
Mailing Address - Country:US
Mailing Address - Phone:612-884-0649
Mailing Address - Fax:612-676-8992
Practice Address - Street 1:909 FULTON ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-0000
Practice Address - Country:US
Practice Address - Phone:612-884-0649
Practice Address - Fax:612-676-8992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-18
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography