Provider Demographics
NPI:1447201421
Name:PARK NICOLLET METHODIST HOSPITAL
Entity Type:Organization
Organization Name:PARK NICOLLET METHODIST HOSPITAL
Other - Org Name:PARK NICOLLET METHODIST HOSPITAL HOMECARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LUHRS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-883-7158
Mailing Address - Street 1:8170 33RD AVENUE SOUTH
Mailing Address - Street 2:MAILSTOP 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6500 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4702
Practice Address - Country:US
Practice Address - Phone:952-993-6807
Practice Address - Fax:952-993-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN329934251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN247151Medicare ID - Type Unspecified