NPIMap

Organization Active NPI

Specialized Treatment Services, Inc. - Brooklyn Park

  • Methadone Clinic
  • Brooklyn Park, MN
National Provider Identifier
1023362027
Registry record updated Nov 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
License
1063313 Issued in MN
Legal business name
SPECIALIZED TREATMENT SERVICES, INC. - BROOKLYN PARK
Practice address
7472 Lakeland Blvd
Brooklyn Park, MN 55428-0000
Phone
(612) 236-1700
Fax
(612) 236-1743
NPI assigned
Oct 30, 2012
Organization subpart
Yes
Parent organization
SPECIALIZED TREATMENT SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 1, 2012

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

Authorized official

Name
Mr. Cory William Edward Veeck
Title
Billing Manager
Phone
(612) 902-5916

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X 1063313 MN Primary

Addresses

Primary practice location

7472 Lakeland Blvd
Brooklyn Park, MN 55428-0000

Mailing address

1132 Central Ave NE
Minneapolis, MN 55413-1512
Phone (612) 236-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Opioid treatment program
Medicare-enrolled since May 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200623000876 MN Part B Supplier - Opioid Treatment Program (Otp) 2466874342 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brooklyn Park, MN; Minneapolis, MN; Saint Paul, MN

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Specialized Treatment Services Inc - Brooklyn Park8 organizations share this tax ID, including this one
Part of
Specialized Treatment Services Inc - Brooklyn Park

Other organizations with this tax ID 7

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

Locations

7472 Lakeland Ave N
Brooklyn Park, MN 55428
Phone (612) 236-1700

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351728000000",
    "number": "1023362027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1132 CENTRAL AVE NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554131512",
            "telephone_number": "612-236-1700",
            "fax_number": "612-236-1743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7472 LAKELAND BLVD",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554280000",
            "telephone_number": "612-236-1700",
            "fax_number": "612-236-1743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALIZED TREATMENT SERVICES, INC. - BROOKLYN PARK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECIALIZED TREATMENT SERVICES, INC.",
        "enumeration_date": "2012-10-30",
        "last_updated": "2012-11-01",
        "status": "A",
        "authorized_official_last_name": "VEECK",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "WILLIAM EDWARD",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "612-902-5916",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "MN",
            "license": "1063313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.