NPIMap

Organization Active NPI

Great River Endodontics, PA

  • Endodontics
  • Willmar, MN
National Provider Identifier
1144583527
Registry record updated Jun 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
11880 Issued in MN
Legal business name
GREAT RIVER ENDODONTICS, PA
Practice address
1100 19TH Ave SW
Willmar, MN 56201-5006
Phone
(320) 259-5078
Fax
(320) 259-5078
NPI assigned
Jun 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2012

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

Authorized official

Name
Dr. Thomas Andrew Karn, DMDNPI 1578638946
Title
Owner/President
Phone
(320) 259-5078

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X 11880 MN Primary

Addresses

Primary practice location

1100 19TH Ave SW
Willmar, MN 56201-5006

Mailing address

622 Roosevelt Rd Ste 180
Saint Cloud, MN 56301-6361
Phone (320) 259-5078

National Provider Directory

National Provider Directory
Tax ID family
Great River Endodontics PA4 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.

Locations

1100 19th Ave SW
Willmar, MN 56201
Phone (320) 253-0272

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340150400000",
    "number": "1144583527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 ROOSEVELT RD STE 180",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563016361",
            "telephone_number": "320-259-5078",
            "fax_number": "320-259-1484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 19TH AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562015006",
            "telephone_number": "320-259-5078",
            "fax_number": "320-259-5078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT RIVER ENDODONTICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2012-06-20",
        "status": "A",
        "authorized_official_last_name": "KARN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "320-259-5078",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "MN",
            "license": "11880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willmar, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; 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.