Healthcare Provider Details

I. General information

NPI: 1275842007
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL & CLINICS OF MN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

2525 CHICAGO AVENUE SOUTH
MINNEAPOLIS MN
55404
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-7259
  • Fax:
Mailing address:
  • Phone: 612-813-7259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: DIANE ALEXANDER
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 612-813-7259