Provider Demographics
NPI:1851569909
Name:MINNESOTA ONCOLOGY HEMATOLOGY, PA
Entity type:Organization
Organization Name:MINNESOTA ONCOLOGY HEMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-602-5266
Mailing Address - Street 1:6363 FRANCE AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2129
Mailing Address - Country:US
Mailing Address - Phone:952-928-2900
Mailing Address - Fax:952-928-2944
Practice Address - Street 1:6363 FRANCE AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2129
Practice Address - Country:US
Practice Address - Phone:952-928-2900
Practice Address - Fax:952-928-2944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1076363AS0400X, 364SA2200X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC01828Medicare PIN