Provider Demographics
NPI:1013137355
Name:REGENTS OF THE UNIVERSITY OF MINNESOTA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF MINNESOTA
Other - Org Name:BOYNTON HEALTH SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR AND CHIEF HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-625-5992
Mailing Address - Street 1:410 CHURCH STREET SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0346
Mailing Address - Country:US
Mailing Address - Phone:612-625-8400
Mailing Address - Fax:612-625-1434
Practice Address - Street 1:410 CHURCH ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0340
Practice Address - Country:US
Practice Address - Phone:612-625-8400
Practice Address - Fax:612-625-1434
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF MINNESOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-27
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN322012500Medicaid
MN322012500Medicaid