Provider Demographics
NPI:1497940860
Name:THE SAINT PAUL LUNG CLINIC
Entity Type:Organization
Organization Name:THE SAINT PAUL LUNG CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-726-6210
Mailing Address - Street 1:225 SMITH AVE N STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2592
Mailing Address - Country:US
Mailing Address - Phone:651-726-6200
Mailing Address - Fax:
Practice Address - Street 1:225 SMITH AVE N STE 300
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2592
Practice Address - Country:US
Practice Address - Phone:651-726-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-157185-5363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty