Healthcare Provider Details

I. General information

NPI: 1083881452
Provider Name (Legal Business Name): MINNESOTA STATE COLLEGES AND UNIVERSITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 BIRCHMONT DR NE
BEMIDJI MN
56601-1003
US

IV. Provider business mailing address

1500 BIRCHMONT DR NE # 42
BEMIDJI MN
56601-2600
US

V. Phone/Fax

Practice location:
  • Phone: 218-755-2053
  • Fax: 218-755-2750
Mailing address:
  • Phone: 218-755-2053
  • Fax: 218-755-2750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateMN

VIII. Authorized Official

Name: JENNIFER FRAIK
Title or Position: DIRECTOR, STUDENT CENTER
Credential:
Phone: 218-755-2871