Parkside Health Care, LLC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

PARKSIDE HEALTH CARE, LLC

Practice address

8609 Lyndale Ave S
Suite 105B
Bloomington, MN 55420-2754

Phone

(952) 303-3104

NPI assigned

Jul 19, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Beverly Buckner

Title

Owner/Director

Phone

(952) 303-3104

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184803200000",
    "number": "1316147135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8609 LYNDALE AVE S",
            "address_2": "SUITE 105B",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554202754",
            "telephone_number": "952-303-3104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8609 LYNDALE AVE S",
            "address_2": "SUITE 105B",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554202754",
            "telephone_number": "952-303-3104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKSIDE HEALTH CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-19",
        "last_updated": "2007-07-19",
        "status": "A",
        "authorized_official_last_name": "BUCKNER",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "952-303-3104",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; 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.