NPIMap

Organization Active NPI

Minnesota State Colleges

Doing business as St. Cloud State University Health Service

  • Clinic Pharmacy
  • Saint Cloud, MN
National Provider Identifier
1073581302
Registry record updated Oct 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
200814 Issued in MN
Legal business name
MINNESOTA STATE COLLEGES
Doing business as
St. Cloud State University Health Service
Practice address
251 6TH St S
Saint Cloud, MN 56301-4491
Phone
(320) 308-4852
Fax
(320) 308-4878
NPI assigned
Mar 11, 2006
Last updated
Oct 11, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2016

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

Authorized official

Name
Lynn Leaf, BS
Title
Pharmacist in Charge
Phone
(320) 308-4852

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Clinic Pharmacy 3336C0002X 200814 MN Primary

Addresses

Primary practice location

251 6TH St S
Saint Cloud, MN 56301-4491

Mailing address

720 4TH Ave S
Saint Cloud, MN 56301-4442
Phone (320) 308-4852

Other identifiers 2

IdentifierTypeStateIssuer
492760500MedicaidMN
2045128OtherPK

Other names 1

  • ST. CLOUD STATE UNIVERSITY HEALTH SERVICE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Minnesota State Colleges Universities27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1142035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476144000000",
    "number": "1073581302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 4TH AVE S",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014442",
            "telephone_number": "320-308-4852",
            "fax_number": "320-308-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 6TH ST S",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014491",
            "telephone_number": "320-308-4852",
            "fax_number": "320-308-4878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA STATE COLLEGES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-11",
        "last_updated": "2016-10-11",
        "status": "A",
        "authorized_official_last_name": "LEAF",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "320-308-4852",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "MN",
            "license": "200814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "492760500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2045128",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST. CLOUD STATE UNIVERSITY HEALTH SERVICE",
            "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 Oct 11, 2016; 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.