Provider Demographics
NPI:1356671754
Name:ON CALL CLINICIANS, INC.
Entity type:Organization
Organization Name:ON CALL CLINICIANS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:M A
Authorized Official - Phone:763-545-6017
Mailing Address - Street 1:5861 CEDAR LAKE RD S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1481
Mailing Address - Country:US
Mailing Address - Phone:763-544-1000
Mailing Address - Fax:763-541-1076
Practice Address - Street 1:5861 CEDAR LAKE RD S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-1481
Practice Address - Country:US
Practice Address - Phone:763-544-1000
Practice Address - Fax:763-541-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7810261QH0700X
MNLP0508261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech