Provider Demographics
NPI:1629373246
Name:TOTAL HEALTHCARE AND PHYSICAL MEDICINE PLLC.
Entity Type:Organization
Organization Name:TOTAL HEALTHCARE AND PHYSICAL MEDICINE PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KOULA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-636-5560
Mailing Address - Street 1:2151 HAMLINE AVE N
Mailing Address - Street 2:STE. 111
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4236
Mailing Address - Country:US
Mailing Address - Phone:651-636-5560
Mailing Address - Fax:651-636-4406
Practice Address - Street 1:2151 HAMLINE AVE N
Practice Address - Street 2:STE. 111
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4236
Practice Address - Country:US
Practice Address - Phone:651-636-5560
Practice Address - Fax:651-636-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30851208D00000X
MN13954363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty