Provider Demographics
NPI:1558392852
Name:NORTH MEMORIAL HEALTH CARE
Entity Type:Organization
Organization Name:NORTH MEMORIAL HEALTH CARE
Other - Org Name:NORTH MEMORIAL HEALTH CLINIC - MAPLE GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FROMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-581-4614
Mailing Address - Street 1:9855 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4648
Mailing Address - Country:US
Mailing Address - Phone:763-581-2273
Mailing Address - Fax:763-581-4561
Practice Address - Street 1:9855 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4648
Practice Address - Country:US
Practice Address - Phone:763-581-2273
Practice Address - Fax:763-581-4561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH MEMORIAL HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
23575OtherHEALTH PARTNERS
MN01003BAOtherBCBS
111358OtherUCARE
9804445OtherMEDICA
NM105OtherPREFERRED ONE
9804445OtherMEDICA
CG2648Medicare PIN
MN761712700Medicaid