Prairie St. John'S Clinic

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

License

5063A Issued in ND

Legal business name

PRAIRIE ST. JOHN'S CLINIC

Practice address

7616 Currell Blvd
Suite 100
Woodbury, MN 55125-2290

Phone

(651) 259-9700

Fax

(651) 259-9740

NPI assigned

Oct 11, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jerry W Magnison, CFO

Title

Chief Financial Officer

Phone

(701) 476-7221

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Prairie St John'S Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Prairie St. John'S Clinic

  • Social Worker
  • Saint Paul, MN
  • NPI 1518059690
  NPD tax ID
• Prairie St. Johns

  • Children's Hospital
  • Minnetonka, MN
  • NPI 1235260993
  NPD tax ID
• Prairie St. John'S, LLC

  • Substance Abuse Rehabilitation Facility
  • Fargo, ND
  • NPI 1366681918
  NPD tax ID

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073601258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 4TH ST S",
            "address_2": "PO BOX 2027",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031914",
            "telephone_number": "701-476-7221",
            "fax_number": "701-476-7261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7616 CURRELL BLVD",
            "address_2": "SUITE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252290",
            "telephone_number": "651-259-9700",
            "fax_number": "651-259-9740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE ST. JOHN'S CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAGNISON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "701-476-7221",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "ND",
            "license": "5063A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA BLUE CROSS",
            "identifier": "238T5PR",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judy A Powell, MS, LADC
• Richard R Powell, DDS
• Tyler Marie Powers, MA
• Katrin A. Pownell, CRNA
• Prairie Care
• Chelsey Prall, DO
• David Nathan Prall, M.D.
• Roan Sigrid V Precilla, MD
• Christina Preimesberger
• Prelude Homes & Services

• Adolescent and Children Mental Health Clinic/Center in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Adolescent and Children Mental Health Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.