=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780186486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIMPLICITY HEALTH PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2018
-----------------------------------------------------
Last Update Date | 02/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3290 42ND AVENUE SOUTH SUITE 100
-----------------------------------------------------
City | ST CLOUD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-267-1341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1511 NORTHWAY DR STE 103
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56303-1262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-267-1341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | DR. JULIE K ANDERSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 320-267-1341
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 43953
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------