Provider Demographics
NPI:1912367368
Name:TWIN CITIES ANAPLASTOLOGY
Entity Type:Organization
Organization Name:TWIN CITIES ANAPLASTOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-340-5594
Mailing Address - Street 1:1880 LIVINGSTON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:WEST SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3426
Mailing Address - Country:US
Mailing Address - Phone:651-340-5594
Mailing Address - Fax:844-632-8258
Practice Address - Street 1:1880 LIVINGSTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3426
Practice Address - Country:US
Practice Address - Phone:651-340-5594
Practice Address - Fax:844-632-8258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-28
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7572570001Medicare NSC