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1760541700

NPI Code Detail

MEDICARE: GILLETTE CHILDRENS SPECIALTY HEALTHCARE

MEDICARE: GILLETTE CHILDRENS SPECIALTY HEALTHCARE

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	332BC3200X	Customized Equipment (DME)		MN
2	335E00000X	Prosthetic/Orthotic Supplier		MN
3	332B00000X	Durable Medical Equipment & Medical Supplies		MN
4	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	1111HGI	OTHER		BLUE CROSS BLUE SHIELD
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760541700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILLETTE CHILDRENS SPECIALTY HEALTHCARE

Provider Business Mailing Address
First Line	:	200 UNIVERSITY AVE E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55101-2507
Country	:	US
Telephone Number	:	651-325-2177
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 PHALEN BLVD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-5302
Country	:	US
Telephone Number	:	651-636-9443
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	PATRICK NOLAN
Credential	:
Telephone Number	:	651-312-3105

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	04/06/2026

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Directions to “GILLETTE CHILDRENS SPECIALTY HEALTHCARE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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