Healthcare Provider Details

I. General information

NPI: 1740459932
Provider Name (Legal Business Name): CHOICE HEALTHCARE OF MINNESOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 7TH AVE N
HOPKINS MN
55343-7309
US

IV. Provider business mailing address

130 7TH AVE N
HOPKINS MN
55343-7309
US

V. Phone/Fax

Practice location:
  • Phone: 612-296-8095
  • Fax: 952-933-2736
Mailing address:
  • Phone: 612-296-8095
  • Fax: 952-933-2736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberA173908000
License Number StateMN

VIII. Authorized Official

Name: MRS. AMANDA H BIES
Title or Position: SERVICES ADMINISTRATOR
Credential:
Phone: 612-296-8095