Provider Demographics
NPI:1992027007
Name:MORNINGSIDE FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:MORNINGSIDE FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:SIDELL
Authorized Official - Suffix:
Authorized Official - Credentials:M
Authorized Official - Phone:952-926-3002
Mailing Address - Street 1:3920 SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1211
Mailing Address - Country:US
Mailing Address - Phone:952-926-3002
Mailing Address - Fax:952-926-7744
Practice Address - Street 1:3920 SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1211
Practice Address - Country:US
Practice Address - Phone:952-926-3002
Practice Address - Fax:952-926-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31011261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO080001827OtherMEDICARE ID
MNA95189Medicare UPIN