Provider Demographics
NPI:1588695050
Name:INVER GROVE HEIGHTS FAMILY MEDICAL CENTER LTD
Entity type:Organization
Organization Name:INVER GROVE HEIGHTS FAMILY MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:LAMEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:651-451-6954
Mailing Address - Street 1:5972 CAHILL AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-5500
Mailing Address - Country:US
Mailing Address - Phone:651-451-6954
Mailing Address - Fax:651-451-2103
Practice Address - Street 1:5972 CAHILL AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-5500
Practice Address - Country:US
Practice Address - Phone:651-451-6954
Practice Address - Fax:651-451-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC01079Medicare ID - Type Unspecified
MNA94775Medicare UPIN