Provider Demographics
NPI:1730113630
Name:CENTER FOR REPRODUCTIVE MEDICINE PA
Entity type:Organization
Organization Name:CENTER FOR REPRODUCTIVE MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-863-5390
Mailing Address - Street 1:2828 CHICAGO AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1544
Mailing Address - Country:US
Mailing Address - Phone:612-863-5390
Mailing Address - Fax:612-863-2697
Practice Address - Street 1:2828 CHICAGO AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1544
Practice Address - Country:US
Practice Address - Phone:612-863-5390
Practice Address - Fax:612-863-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
138391OtherPATIENT CHOICE
MN88918OtherHEALTH PARTNERS
MN64G41CEOtherBLUE CROSS
MN1032718OtherPREFERRED ONE
=========OtherGREATWEST HEALTHCARE