Provider Demographics
NPI:1992869820
Name:CITY OF BLOOMINGTON
Entity type:Organization
Organization Name:CITY OF BLOOMINGTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, MSN, PHN
Authorized Official - Phone:952-563-8905
Mailing Address - Street 1:1800 W OLD SHAKOPEE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3071
Mailing Address - Country:US
Mailing Address - Phone:952-563-8700
Mailing Address - Fax:952-563-8997
Practice Address - Street 1:1900 W OLD SHAKOPEE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3029
Practice Address - Country:US
Practice Address - Phone:952-563-8900
Practice Address - Fax:952-563-8997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN079553400Medicaid
MN1613BLOtherBLUE CROSS BLUE SHIELD
MN164328OtherUCARE
MN8300076OtherMEDICA
MN885353300Medicaid
MN570001OtherMETROPOLITAN HEALTH PLAN
MN164328OtherUCARE
MN164328OtherUCARE