Provider Demographics
NPI:1740459932
Name:CHOICE HEALTHCARE OF MINNESOTA
Entity type:Organization
Organization Name:CHOICE HEALTHCARE OF MINNESOTA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SERVICES ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-296-8095
Mailing Address - Street 1:130 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7309
Mailing Address - Country:US
Mailing Address - Phone:612-296-8095
Mailing Address - Fax:952-933-2736
Practice Address - Street 1:130 7TH AVE N
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7309
Practice Address - Country:US
Practice Address - Phone:612-296-8095
Practice Address - Fax:952-933-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA173908000305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA173908000OtherUMPI