Provider Demographics
NPI:1790873412
Name:DIAMOND WOMEN'S CENTER, P.A.
Entity Type:Organization
Organization Name:DIAMOND WOMEN'S CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:0PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURGRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:952-928-3677
Mailing Address - Street 1:6545 FRANCE AVE S
Mailing Address - Street 2:SUITE 540
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2131
Mailing Address - Country:US
Mailing Address - Phone:952-927-4045
Mailing Address - Fax:952-924-4133
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:SUITE 540
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2131
Practice Address - Country:US
Practice Address - Phone:952-927-4045
Practice Address - Fax:952-924-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103752OtherUCARE CLINIC PROVIDER #
MN806OtherHEALTPARTNERS PROV #
MNFP100OtherPREFFERED ONE PROVIDER #
MN03451DIOtherBCBS PROVIDER #
MNCP4302OtherMEDICARE RR PALMETTO #
MNCP4302OtherMEDICARE RR PALMETTO #