Healthcare Provider Details

I. General information

NPI: 1093131419
Provider Name (Legal Business Name): GERIATRIC SERVICES OF MINNESOTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 BROADWAY ST NE STE 300
MINNEAPOLIS MN
55413-1761
US

IV. Provider business mailing address

3433 BROADWAY ST NE SUITE 300
MINNEAPOLIS MN
55413-1761
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-7737
  • Fax: 651-383-4551
Mailing address:
  • Phone: 763-587-7737
  • Fax: 763-587-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIA CRIST
Title or Position: CEO
Credential: MHA
Phone: 763-587-7737