Provider Demographics
NPI:1952818023
Name:ALLINA HEALTH SYSTEM
Entity Type:Organization
Organization Name:ALLINA HEALTH SYSTEM
Other - Org Name:ALLINA HEALTH EVERYDAY CLINIC - LAKEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-262-1020
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:ROUTE 10202
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-0043
Mailing Address - Country:US
Mailing Address - Phone:952-428-0101
Mailing Address - Fax:
Practice Address - Street 1:16150 PILOT KNOB RD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-4105
Practice Address - Country:US
Practice Address - Phone:952-428-4225
Practice Address - Fax:952-428-4229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLINA HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-10
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty