=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073637468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED HEALTHCARE SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 07/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9701 DATA PARK MN006-W600
-----------------------------------------------------
City | MINNETONKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55343-9026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-896-8936
-----------------------------------------------------
Fax | 888-866-3209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9701 DATA PARK MN006-W600
-----------------------------------------------------
City | MINNETONKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55343-9026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-896-8936
-----------------------------------------------------
Fax | 888-866-3209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | ALLEN D MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-896-8936
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------