MEDICARE: NORTH CLINIC, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician
2	207V00000X	Obstetrics & Gynecology Physician	123	MN
3	208C00000X	Colon & Rectal Surgery Physician	123	MN
4	213E00000X	Podiatrist
5	213ES0103X	Foot & Ankle Surgery Podiatrist
6	363AM0700X	Medical Physician Assistant	123	MN
7	363LF0000X	Family Nurse Practitioner
8	363LX0001X	Obstetrics & Gynecology Nurse Practitioner
9	207R00000X	Internal Medicine Physician	123	MN
10	207Q00000X	Family Medicine Physician	123	MN

General Provider Information

NPI Number	:	1114962206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CLINIC, PA

Provider Business Mailing Address
First Line	:	9201 W BROADWAY AVE
Second Line	:	SUITE 601
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-1923
Country	:	US
Telephone Number	:	763-587-7900
Fax Number	:	763-587-7066

Provider Business Practice Location Address
First Line	:	9201 W BROADWAY AVE STE 601
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-1924
Country	:	US
Telephone Number	:	763-587-7900
Fax Number	:	763-587-7066

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT R COLSON
Credential	:	MD
Telephone Number	:	763-587-7900

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	12/23/2022

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Practice Location Address:

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