Provider Demographics
NPI:1740578749
Name:MINNESOTA ARTHRITIS CENTER, PA
Entity Type:Organization
Organization Name:MINNESOTA ARTHRITIS CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-282-0948
Mailing Address - Street 1:2785 WHITE BEAR AVE N
Mailing Address - Street 2:SUITE 108 B
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1307
Mailing Address - Country:US
Mailing Address - Phone:651-282-0948
Mailing Address - Fax:651-415-0106
Practice Address - Street 1:2785 WHITE BEAR AVE N
Practice Address - Street 2:SUITE 108B
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1307
Practice Address - Country:US
Practice Address - Phone:651-282-0948
Practice Address - Fax:651-415-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35768207R00000X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6676240001Medicare NSC
MNCO5963Medicare PIN