Healthcare Provider Details

I. General information

NPI: 1851569909
Provider Name (Legal Business Name): MINNESOTA ONCOLOGY HEMATOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 FRANCE AVE S SUITE 200
EDINA MN
55435-2129
US

IV. Provider business mailing address

6363 FRANCE AVE S SUITE 200
EDINA MN
55435-2129
US

V. Phone/Fax

Practice location:
  • Phone: 952-928-2900
  • Fax: 952-928-2944
Mailing address:
  • Phone: 952-928-2900
  • Fax: 952-928-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number1076
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1076
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number1076
License Number StateMN

VIII. Authorized Official

Name: KATHRYN M THOMPSON
Title or Position: SR. ADMINISTRATIVE ASSISTANT
Credential:
Phone: 651-602-5266