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	261Q00000X	Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1407011760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CLINIC, PA

Provider Business Mailing Address
First Line	:	PO BOX 16800
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-0800
Country	:	US
Telephone Number	:	763-587-7900
Fax Number	:

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	:	SCOTT RICHARD COLSON
Credential	:	MD
Telephone Number	:	763-587-7900

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	12/23/2022

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