Provider Demographics
NPI:1699739045
Name:ALLINA HEALTH SYSTEM
Entity type:Organization
Organization Name:ALLINA HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-262-5992
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 1:11850 BLACKFOOT ST NW STE 190
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2583
Practice Address - Country:US
Practice Address - Phone:763-236-7111
Practice Address - Fax:763-263-9381
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLINA HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-13
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0574863Medicaid
2417219OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MN632616100Medicaid
IA0574863Medicaid