Provider Demographics
NPI:1528364429
Name:RIDGEVIEW MEDICAL CENTER
Entity Type:Organization
Organization Name:RIDGEVIEW MEDICAL CENTER
Other - Org Name:RIDGEVIEW MEDICAL CENTER CRNAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESDIENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-442-2191
Mailing Address - Street 1:14700 28TH AVE N
Mailing Address - Street 2:SUITE 20
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4835
Mailing Address - Country:US
Mailing Address - Phone:763-559-3779
Mailing Address - Fax:763-450-3986
Practice Address - Street 1:500 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1752
Practice Address - Country:US
Practice Address - Phone:952-442-2191
Practice Address - Fax:952-442-8029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIDGEVIEW MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-10
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty