Provider Demographics
NPI:1841523248
Name:MCRH ALPHA MEDICAL, P.A.
Entity type:Organization
Organization Name:MCRH ALPHA MEDICAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LARAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-494-7734
Mailing Address - Street 1:12000 ELM CREEK BLVD N
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7073
Mailing Address - Country:US
Mailing Address - Phone:763-494-7700
Mailing Address - Fax:763-494-7706
Practice Address - Street 1:12000 ELM CREEK BLVD N
Practice Address - Street 2:SUITE 350
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7073
Practice Address - Country:US
Practice Address - Phone:763-494-7700
Practice Address - Fax:763-494-7706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MIDWEST CENTER FOR REPRODUCTIVE HEALTH, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33043207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3D491MIOtherBCBCMN PROVIDER FACILITY
MN3D492OtherBCBSMN PROVIDER
MNE02458OtherUPIN