Provider Demographics
NPI:1124103544
Name:NORTHWESTERN HEALTH SCIENCES UNIVERSITY
Entity type:Organization
Organization Name:NORTHWESTERN HEALTH SCIENCES UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC,JD
Authorized Official - Phone:952-888-4777
Mailing Address - Street 1:2501 WEST 84TH STREET
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1599
Mailing Address - Country:US
Mailing Address - Phone:952-888-4777
Mailing Address - Fax:952-886-7590
Practice Address - Street 1:2501 W 84TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1602
Practice Address - Country:US
Practice Address - Phone:952-888-4777
Practice Address - Fax:952-886-7590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7261471Medicaid
MNC02830Medicare ID - Type Unspecified
MNC01250Medicare ID - Type Unspecified
MNC02942Medicare ID - Type Unspecified
MN7261471Medicaid
MNC00574Medicare ID - Type Unspecified