Provider Demographics
NPI:1316985039
Name:ALLINA HEALTH SYSTEM
Entity type:Organization
Organization Name:ALLINA HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLARICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-222-2222
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:MAIL ROUTE 10585
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-1166
Mailing Address - Fax:
Practice Address - Street 1:2925 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1321
Practice Address - Country:US
Practice Address - Phone:651-635-9173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN362340251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN136951OtherUCARE
MN113996OtherHEALTHPARTNERS
MN50-25375OtherMEDICA CHOICE
MN01029580OtherPREFERREDONE
MN50-25375OtherMEDICA SELECTCARE
MN877602400Medicaid
MN4R85ALOtherBCBS
MN59-00281OtherMEDICA
MN4R85ALOtherBCBS
MNC05680Medicare PIN