Provider Demographics
NPI:1285648295
Name:NORTH MEMORIAL HEALTH CARE
Entity type:Organization
Organization Name:NORTH MEMORIAL HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-581-4635
Mailing Address - Street 1:PO BOX 735463
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5463
Mailing Address - Country:US
Mailing Address - Phone:763-581-2820
Mailing Address - Fax:
Practice Address - Street 1:9825 HOSPITAL DR STE 11
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4479
Practice Address - Country:US
Practice Address - Phone:763-581-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH MEMORIAL HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
96300OtherPREFERREDONE
102369OtherUCARE
MN671323800Medicaid
4T901M1OtherBCBS
30346OtherHEALTH PARTNERS
102369OtherUCARE
30346OtherHEALTH PARTNERS
MN671323800Medicaid