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General NPI Number Information
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NPI Number | 1093994030
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HEALTH CARE
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 2525 CHICAGO AVE. S.
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-4518
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Country | US
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Telephone | 612-813-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 5901 LINCOLN DRIVE, CBC-2-REV/PE
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City | EDINA
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State | MN
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Zip | 55436-1611
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Country | US
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Telephone | 952-992-5691
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Fax | 952-992-6917
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Authorized Official
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Title or Position | SR. VP AND CHIEF FINANCIAL OFFICER
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Name | BRENDA LU ALEXANDER MCCORMICK
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Credential |
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Telephone | 612-813-6129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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