Healthcare Provider Details

I. General information

NPI: 1235304726
Provider Name (Legal Business Name): NORTH CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9825 HOSPITAL DR STE 300
MAPLE GROVE MN
55369-4768
US

IV. Provider business mailing address

9825 HOSPITAL DR STE 300
MAPLE GROVE MN
55369-4768
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-7900
  • Fax: 763-494-7501
Mailing address:
  • Phone: 763-587-7900
  • Fax: 763-494-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number123
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 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 Code363A00000X
TaxonomyPhysician Assistant
License Number123
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number123
License Number StateMN
# 8
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number123
License Number StateMN

VIII. Authorized Official

Name: SCOTT RICHARD COLSON
Title or Position: PRESIDENT
Credential: MD
Phone: 763-587-7900