Provider Demographics
NPI:1528361573
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:C.F.O
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
Mailing Address - Street 2:P1-FINANCE
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 1:300 S 6TH ST
Practice Address - Street 2:GOVERNMENT CENTER-A 120
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55487-0070
Practice Address - Country:US
Practice Address - Phone:612-348-4628
Practice Address - Fax:612-596-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN367142261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN157245800Medicaid
MN157245800Medicaid
MN240004Medicare Oscar/Certification
MNC01999Medicare PIN
MNCD8453Medicare PIN