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General NPI Number Information
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NPI Number | 1447556261
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Entity Type | Organization
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Legal Business Name | ALLINA HEALTH SYSTEM
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 1540 LAKE ST S
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City | FOREST LAKE
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State | MN
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Zip | 55025-2628
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Country | US
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Telephone | 651-464-7100
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Fax | 651-241-1515
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Provider Business Mailing Address
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Address Line | 2925 CHICAGO AVE ROUTE 10202
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1321
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Country | US
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Telephone | 612-262-1166
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Fax |
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Authorized Official
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Title or Position | COO
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Name | DOMINICA TALLARICO
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Credential |
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Telephone | 612-222-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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