Provider Demographics
NPI:1427190537
Name:FAMILY HEALTHSERVICES MINNESOTA, P.A.
Entity Type:Organization
Organization Name:FAMILY HEALTHSERVICES MINNESOTA, P.A.
Other - Org Name:FHSM - MAPLEWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR. OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-625-2990
Mailing Address - Street 1:5810 NANCY RIDGE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2834
Mailing Address - Country:US
Mailing Address - Phone:858-625-2990
Mailing Address - Fax:
Practice Address - Street 1:1814 N SAINT PAUL RD
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-4700
Practice Address - Country:US
Practice Address - Phone:651-777-8393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDVANTX, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-13
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28848332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site