MEDICARE: MEDTRONIC MONITORING, 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	293D00000X	Physiological Laboratory
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1699914150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDTRONIC MONITORING, INC

Provider Business Mailing Address
First Line	:	PO BOX 74008550
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-8550
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 PRESIDENTIAL BLVD
Second Line	:	102
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1008
Country	:	US
Telephone Number	:	610-257-6300
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT AND GENERAL MANAGER
Name	:	MRS. NINA GOODHEART
Credential	:
Telephone Number	:	763-526-2518

Provider Enumeration Date	:	02/06/2009
Last Update Date	:	02/10/2017

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