NW Family Practice Rogers

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

17330 Issued in MN

Legal business name

NW FAMILY PRACTICE ROGERS

Doing business as

NW FAMILY PRACTICE ROGERS

Practice address

21305 John Milless Dr
Rogers, MN 55374-9450

Phone

(612) 428-2206

Fax

(612) 428-2530

NPI assigned

Oct 23, 2006

Organization subpart

No

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

Authorized official

Name

Direndia Shackelford

Title

Managed Care Specialist

Phone

(800) 654-0889

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• NW FAMILY PRACTICE ROGERS Doing business as

Locations

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093898322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21305 JOHN MILLESS DR",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553749450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21305 JOHN MILLESS DR",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553749450",
            "telephone_number": "612-428-2206",
            "fax_number": "612-428-2530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NW FAMILY PRACTICE ROGERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHACKELFORD",
        "authorized_official_first_name": "DIRENDIA",
        "authorized_official_title_or_position": "MANAGED CARE SPECIALIST",
        "authorized_official_telephone_number": "800-654-0889"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "MN",
            "license": "17330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2423616",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NW FAMILY PRACTICE ROGERS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Non-Pharmacy Dispensing Site in Rogers, MN
• Providers in Rogers, MN by specialty
• Non-Pharmacy Dispensing Site 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.