Provider Demographics
NPI:1407897309
Name:HENNEPIN HEALTHCARE SYSTEM, INC
Entity Type:Organization
Organization Name:HENNEPIN HEALTHCARE SYSTEM, INC
Other - Org Name:HENNEPIN COUNTY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
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, P1-FINANCE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-3000
Mailing Address - Fax:612-904-4259
Practice Address - Street 1:701 PARK AVE, P1-FINANCE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-3000
Practice Address - Fax:612-904-4259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
MN331373282N00000X
MN367063282N00000X, 283Q00000X
MN367142282N00000X
MN0157341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No283Q00000XHospitalsPsychiatric HospitalGroup - Multi-Specialty
No341600000XTransportation ServicesAmbulanceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1020HHEOtherBLUE CROSS
MN157245800Medicaid
MN06922HEOtherBLUE SHIELD
MN64788HEOtherBLUE SHIELD
MN240004Medicare Oscar/Certification
MNC01999Medicare PIN
MN157245800Medicaid
MNC04460Medicare PIN
MNC04460Medicare PIN