Provider Demographics
NPI:1528259132
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:DOMINCA
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:MR 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 1:2833 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1319
Practice Address - Country:US
Practice Address - Phone:612-863-3333
Practice Address - Fax:612-863-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCC6504OtherRAILROAD MEDICARE
MN89605OtherHEALTHPARTNERS
MNAM902OtherPREFERREDONE
MNJ625OtherUCARE OF MN
MN367271200OtherACS DEPT OF LABOR
MN440M3ABOtherBLUECROSS BLUESHIELD
MN794692900Medicaid
MNAM902OtherPREFERREDONE
MNJ625OtherUCARE OF MN
MN240057Medicare Oscar/Certification