NPIMap

Organization Active NPI

Columbia Park Medical Group, PA

  • Clinic Pharmacy
  • Columbia Heights, MN
National Provider Identifier
1326148271
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
261734-9 Issued in MN
Legal business name
COLUMBIA PARK MEDICAL GROUP, PA
Practice address
4000 Central Ave NE
Columbia Heights, MN 55421-2968
Phone
(763) 572-5710
Fax
(763) 782-8100
NPI assigned
Sep 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
John Louis Weir
Title
Executive Director
Phone
(763) 586-5877

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 261734-9 MN Primary

Addresses

Primary practice location

4000 Central Ave NE
Columbia Heights, MN 55421-2968

Mailing address

6401 University Ave NE
Fridley, MN 55432-4341
Phone (763) 572-5710

Other identifiers 5

IdentifierTypeStateIssuer
02991COOtherMNBCBS DME NUMBER
23953OtherMNANDA #
24-23387OtherMNNABP
10039288OtherMNIPC NUMBER
895065OtherMNMCKESSON

Other names 1

  • CPMG-Columbia Park Pharmacy Other name

National Provider Directory

National Provider Directory
Tax ID family
Columbia Park CL Gen PR12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

4000 Central Ave NE
Saint Anthony, MN 55421
Phone (763) 572-5700

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1326148271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6401 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554324341",
            "telephone_number": "763-572-5710",
            "fax_number": "763-571-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 CENTRAL AVE NE",
            "city": "COLUMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554212968",
            "telephone_number": "763-572-5710",
            "fax_number": "763-782-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA PARK MEDICAL GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "WEIR",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "763-586-5877"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "MN",
            "license": "261734-9",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS DME NUMBER",
            "identifier": "02991CO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANDA #",
            "identifier": "23953",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "24-23387",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IPC NUMBER",
            "identifier": "10039288",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCKESSON",
            "identifier": "895065",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CPMG-Columbia Park Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Columbia Heights, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.