MEDICARE: MEDTRONIC MONITORING, INC

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1558845628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDTRONIC MONITORING, INC

Provider Business Mailing Address
First Line	:	800 53RD AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-1241
Country	:	US
Telephone Number	:	888-247-7449
Fax Number	:	763-355-3450

Provider Business Practice Location Address
First Line	:	800 53RD AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-1241
Country	:	US
Telephone Number	:	888-247-7449
Fax Number	:	763-355-3450

Authorized Official
Title or Position	:	VICE PRESIDENT/GENERAL MANAGER
Name	:	MR. JAMES VOGL
Credential	:
Telephone Number	:	763-526-0874

Provider Enumeration Date	:	09/24/2018
Last Update Date	:	09/24/2018

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