Healthcare Provider Details

I. General information

NPI: 1942501689
Provider Name (Legal Business Name): HEALTHSOURCE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10159 WAYZATA BLVD SUITE 100
MINNETONKA MN
55305-1504
US

IV. Provider business mailing address

10159 WAYZATA BLVD SUITE 100
MINNETONKA MN
55305-1504
US

V. Phone/Fax

Practice location:
  • Phone: 763-287-0740
  • Fax: 763-287-0789
Mailing address:
  • Phone: 763-287-0740
  • Fax: 763-287-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateMN

VIII. Authorized Official

Name: MR. EDWARD T BOYLE
Title or Position: CEO
Credential:
Phone: 763-287-0740