Provider Demographics
NPI:1336185651
Name:ALLINA HEALTH SYSTEM
Entity Type:Organization
Organization Name:ALLINA HEALTH SYSTEM
Other - Org Name:ALLINA HEALTH CANCER INSTITUTE - MINNEAPOLIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLARICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-222-2222
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:MR 10860
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-1166
Mailing Address - Fax:
Practice Address - Street 1:800 E 28TH ST STE 401
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0036009OtherMEDICA CHOICE
MN49P33VIOtherBCBS
MN29559OtherHEALTHPARTNERS
MN96546OtherPREFERREDONE
MN137745100Medicaid
MN29559OtherHEALTHPARTNERS
MN240057Medicare Oscar/Certification