Provider Demographics
NPI:1881813038
Name:ABBOTT NORTHWESTERN HOSPITAL
Entity type:Organization
Organization Name:ABBOTT NORTHWESTERN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:KEIZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-645-7277
Mailing Address - Street 1:1425 JESSAMINE AVE W
Mailing Address - Street 2:APT 208
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2685
Mailing Address - Country:US
Mailing Address - Phone:651-645-7277
Mailing Address - Fax:
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit