=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366751521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2010
-----------------------------------------------------
Last Update Date | 10/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 SMITH AVE N MAIL ROUTE 660104
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55102-2344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-241-8290
-----------------------------------------------------
Fax | 651-241-7177
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 SMITH AVE N MAIL ROUTE 660104
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55102-2344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-241-8290
-----------------------------------------------------
Fax | 651-241-7177
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REHAB SERVICES LEADER
-----------------------------------------------------
Name | DR. TREVOR CARLSON
-----------------------------------------------------
Credential | PHYSICAL THERAPIST
-----------------------------------------------------
Telephone | 651-241-8290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 8594
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------