Provider Demographics
NPI:1841043296
Name:DOCTORS AT HOME PC
Entity type:Organization
Organization Name:DOCTORS AT HOME PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MAXWELL
Authorized Official - Last Name:SHIPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-525-5635
Mailing Address - Street 1:12600 WHITEWATER DR STE 125
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-4602
Mailing Address - Country:US
Mailing Address - Phone:952-562-1235
Mailing Address - Fax:
Practice Address - Street 1:12600 WHITEWATER DR STE 125
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-4602
Practice Address - Country:US
Practice Address - Phone:952-562-1235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty