NPIMap

Organization Active NPI

Minnesota Head and Neck Pain Clinic, PA

  • Orofacial Pain Dentistry
  • Saint Cloud, MN
National Provider Identifier
1003316852
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orofacial Pain DentistryTaxonomy code 1223X2210X
Legal business name
MINNESOTA HEAD AND NECK PAIN CLINIC, PA
Practice address
622 Roosevelt Rd
Saint Cloud, MN 56301-6153
Phone
(763) 577-2484
Fax
(763) 577-1375
NPI assigned
Feb 19, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tia A Reichert
Title
Chro/Clinic Admin
Phone
(763) 577-2484

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orofacial Pain DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X2210X Primary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X

Addresses

Primary practice location

622 Roosevelt Rd
Saint Cloud, MN 56301-6153

Mailing address

3475 Plymouth Blvd Ste 200
Plymouth, MN 55447-1539
Phone (763) 577-2484

Other names 1

  • Minnesota Head & Neck Pain Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Head Neck Pain5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

622 Roosevelt Rd
Saint Cloud, MN 56301
Phone (763) 577-2484

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/13597/brand/1/csg/1/fhir/r4

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1003316852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3475 PLYMOUTH BLVD STE 200",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554471539",
            "telephone_number": "763-577-2484",
            "fax_number": "763-577-1375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 ROOSEVELT RD",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563016153",
            "telephone_number": "763-577-2484",
            "fax_number": "763-577-1375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA HEAD AND NECK PAIN CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-19",
        "last_updated": "2024-07-17",
        "certification_date": "2023-10-16",
        "status": "A",
        "authorized_official_last_name": "REICHERT",
        "authorized_official_first_name": "TIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHRO/CLINIC ADMIN",
        "authorized_official_telephone_number": "763-577-2484"
    },
    "taxonomies": [
        {
            "code": "1223X2210X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orofacial Pain",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minnesota Head & Neck Pain Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Minnesota Head & Neck Pain Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.