Provider Demographics
NPI:1639262785
Name:CHILDRENS HEALTH CARE
Entity Type:Organization
Organization Name:CHILDRENS HEALTH CARE
Other - Org Name:CHILDRENS HOSPITALS AND CLINICS OF MINNESOTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:OSTENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-813-6129
Mailing Address - Street 1:5901 LINCOLN DRIVE, CBC-2-REV/PE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1611
Mailing Address - Country:US
Mailing Address - Phone:952-992-5398
Mailing Address - Fax:952-992-6917
Practice Address - Street 1:345 NORTH SMITH AVENUE
Practice Address - Street 2:CHILDRENS HOSPITALS AND CLINICS EMERGENCY PHYSICIANS
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331019261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN141847500Medicaid
C02052Medicare ID - Type Unspecified