Healthcare Provider Details

I. General information

NPI: 1871780478
Provider Name (Legal Business Name): MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S MAPLE ST
WACONIA MN
55387-1752
US

IV. Provider business mailing address

PO BOX 46100
PLYMOUTH MN
55446-0100
US

V. Phone/Fax

Practice location:
  • Phone: 952-442-7843
  • Fax:
Mailing address:
  • Phone: 763-553-9920
  • Fax: 763-553-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN C NIELSEN
Title or Position: DIRECTOR
Credential: MHA
Phone: 952-442-2191