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General NPI Number Information
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NPI Number | 1770028748
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Entity Type | Organization
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Legal Business Name | MAPLE GROVE HOSPITAL CORPORATION
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Dates
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Enumeration Date | 12/30/2016
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 9875 HOSPITAL DR
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4648
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Country | US
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Telephone | 763-581-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 9875 HOSPITAL DR
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4648
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Country | US
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Telephone | 763-581-1000
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Fax |
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Authorized Official
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Title or Position | INTERIM CFO
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Name | STEPHANIE R GALE
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Credential |
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Telephone | 763-581-4635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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