Healthcare Provider Details

I. General information

NPI: 1942424742
Provider Name (Legal Business Name): PARK NICOLLET METHODIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 EXCELSIOR BLVD
ST LOUIS PARK MN
55426-4702
US

IV. Provider business mailing address

4916 EXCELSIOR BLVD
ST LOUIS PARK MN
55416-3032
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-5000
  • Fax: 952-993-1980
Mailing address:
  • Phone: 952-993-5670
  • Fax: 952-993-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: JASON JAMES LUHRS
Title or Position: VP FINANCE
Credential:
Phone: 952-883-7158