Provider Demographics
NPI:1902839947
Name:TWO RIVERS LUNG SPECIALISTS, P. A.
Entity Type:Organization
Organization Name:TWO RIVERS LUNG SPECIALISTS, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:763-236-9494
Mailing Address - Street 1:4040 COON RAPIDS BLVD NW
Mailing Address - Street 2:SUITE #100
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2522
Mailing Address - Country:US
Mailing Address - Phone:763-236-9494
Mailing Address - Fax:763-236-9495
Practice Address - Street 1:4040 COON RAPIDS BLVD NW
Practice Address - Street 2:SUITE #100
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2522
Practice Address - Country:US
Practice Address - Phone:763-236-9494
Practice Address - Fax:763-236-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1564207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN83654OtherHEALTH PART
MNCJ7024OtherRAILROAD MEDICARE
MN142464OtherUCARE
MN0001OtherMEDICA
MN193J9TWOtherBCBS OF MN
MN788700100Medicaid
MNCJ7024OtherRAILROAD MEDICARE
MN788700100Medicaid