Provider Demographics
NPI:1689600983
Name:NORTH MEMORIAL HEALTH CARE
Entity Type:Organization
Organization Name:NORTH MEMORIAL HEALTH CARE
Other - Org Name:NORTH MEMORIAL HEALTH CLINIC - GOLDEN VALLEY FAMILY PHYSICIANS
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 1:8301 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4435
Mailing Address - Country:US
Mailing Address - Phone:763-581-5150
Mailing Address - Fax:763-581-5151
Practice Address - Street 1:8301 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4435
Practice Address - Country:US
Practice Address - Phone:763-581-5150
Practice Address - Fax:763-581-5151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH MEMORIAL HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-25
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
32363OtherHEALTH PARTNERS
NM102OtherPREFERRED ONE
MN8T348DOOtherBCBS
9801039OtherMEDICA
107822OtherUCARE
MN482717100Medicaid
C01835Medicare ID - Type Unspecified
32363OtherHEALTH PARTNERS