NPIMap

Organization Active NPI

Grand Itasca Clinic and Hospital

  • Non-Pharmacy Dispensing Site
  • Grand Rapids, MN
National Provider Identifier
1023326980
Registry record updated Sep 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
GRAND ITASCA CLINIC AND HOSPITAL
Practice address
1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone
(218) 326-7503
NPI assigned
Sep 14, 2010
Organization subpart
Yes
Parent organization
GRAND ITASCA CLINIC AND HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 14, 2010

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

Authorized official

Name
Melissa Walters
Title
Director of Pharmacy
Phone
(952) 653-2565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

1601 Golf Course Rd
Grand Rapids, MN 55744-8648

Mailing address

6501 City West Pkwy
Eden Prairie, MN 55344-3248
Phone (952) 653-2565

National Provider Directory

National Provider Directory
Tax ID family
Grand Itasca Clinic Hosp3 organizations share this tax ID, including this one
Part of
Grand Itasca Clinic Hosp

Other organizations with this tax ID 2

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1284422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284422400000",
    "number": "1023326980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 CITY WEST PKWY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443248",
            "telephone_number": "952-653-2565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 GOLF COURSE RD",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557448648",
            "telephone_number": "218-326-7503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND ITASCA CLINIC AND HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRAND ITASCA CLINIC AND HOSPITAL",
        "enumeration_date": "2010-09-14",
        "last_updated": "2010-09-14",
        "status": "A",
        "authorized_official_last_name": "WALTERS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "952-653-2565"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2010; 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.