Provider Demographics
NPI:1356369524
Name:HENNEPIN HEALTHCARE SYSTEM, INC
Entity type:Organization
Organization Name:HENNEPIN HEALTHCARE SYSTEM, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-873-5340
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:P1-FINANCE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-3000
Mailing Address - Fax:612-904-4259
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:P1-FINANCE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-3000
Practice Address - Fax:612-904-4259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN367142273R00000X
MN367063273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41-6005801OtherEMPLOYER IDENTIFICATION N
MN157245800Medicaid
MN06922HEOtherBLUE SHIELD
MN1020HHEOtherBLUE CROSS
MN157245802Medicaid
MN64788HEOtherBLUE SHIELD
MN=========OtherEMPLOYER IDENTIFICATION N
MNC01999Medicare PIN
MNCD8453Medicare PIN
MN157245802Medicaid