Healthcare Provider Details

I. General information

NPI: 1750863510
Provider Name (Legal Business Name): ALLINA HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9409 ZANE AVE N
BROOKLYN PARK MN
55443-1814
US

IV. Provider business mailing address

PO BOX 43 MAIL ROUTE 10202
MINNEAPOLIS MN
55407
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-5140
  • Fax: 952-428-5147
Mailing address:
  • Phone: 612-262-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RICHARD MAGNUSON
Title or Position: CFO
Credential:
Phone: 612-262-1020