Provider Demographics
NPI:1942424742
Name:PARK NICOLLET METHODIST HOSPITAL
Entity Type:Organization
Organization Name:PARK NICOLLET METHODIST HOSPITAL
Other - Org Name:PARK NICOLLET METHODIST HOSPITAL HOME CARE IV THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LUHRS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-883-7158
Mailing Address - Street 1:4916 EXCELSIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3032
Mailing Address - Country:US
Mailing Address - Phone:952-993-5670
Mailing Address - Fax:952-993-5354
Practice Address - Street 1:4916 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3032
Practice Address - Country:US
Practice Address - Phone:952-993-5000
Practice Address - Fax:952-993-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN329934251F00000X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0356900001Medicare NSC