MEDICARE: DYNAMIC HEALTH CONCEPTS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	327466	MN

General Provider Information

NPI Number	:	1457355240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC HEALTH CONCEPTS, INC.

Provider Business Mailing Address
First Line	:	715 W 31ST ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2915
Country	:	US
Telephone Number	:	612-823-7286
Fax Number	:	612-823-0518

Provider Business Practice Location Address
First Line	:	715 W 31ST ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2915
Country	:	US
Telephone Number	:	612-823-7286
Fax Number	:	612-823-0518

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RANDAL L HAGEMEYER
Credential	:
Telephone Number	:	612-823-7286

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	08/22/2020

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