Provider Demographics
NPI:1205924156
Name:MCGOWAN, RUTH H (PA-C)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:H
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 HAZELWOOD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1242
Mailing Address - Country:US
Mailing Address - Phone:651-232-7800
Mailing Address - Fax:651-232-7940
Practice Address - Street 1:2945 HAZELWOOD ST STE 100
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1242
Practice Address - Country:US
Practice Address - Phone:651-232-7800
Practice Address - Fax:651-232-7940
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001738363AM0700X
CAPA22945363AM0700X
MN12697363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00466587OtherRR MEDICARE
IA1205924156Medicaid
CACI654AMedicare PIN
IA06700004Medicare PIN
IAI1416007Medicare PIN
IAI1421002Medicare PIN
IAP00466587OtherRR MEDICARE