Healthcare Provider Details

I. General information

NPI: 1114962206
Provider Name (Legal Business Name): NORTH CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W BROADWAY AVE STE 601
BROOKLYN PARK MN
55445-1924
US

IV. Provider business mailing address

9201 W BROADWAY AVE SUITE 601
BROOKLYN PARK MN
55445-1923
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-7900
  • Fax: 763-587-7066
Mailing address:
  • Phone: 763-587-7900
  • Fax: 763-587-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number123
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number123
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number123
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number123
License Number StateMN
# 10
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number123
License Number StateMN

VIII. Authorized Official

Name: DR. SCOTT R COLSON
Title or Position: PRESIDENT
Credential: MD
Phone: 763-587-7900