Provider Demographics
NPI:1407011760
Name:NORTH CLINIC, PA
Entity Type:Organization
Organization Name:NORTH CLINIC, PA
Other - Org Name:VOYAGE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:COLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-587-7900
Mailing Address - Street 1:PO BOX 16800
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-0800
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:
Practice Address - Street 1:9201 W BROADWAY AVE STE 601
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-1924
Practice Address - Country:US
Practice Address - Phone:763-587-7900
Practice Address - Fax:763-587-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherTAX ID