Columbia Park Medical Group, PA

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

COLUMBIA PARK MEDICAL GROUP, PA

Practice address

6341 University Ave NE
Fridley, MN 55432-4946

Phone

(763) 572-5710

Fax

(763) 586-5888

NPI assigned

Sep 20, 2006

Organization subpart

Yes

Parent organization

COLUMBIA PARK MEDICAL GROUP, PAAs reported in NPPES

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

Authorized official

Name

Joen V Condon

Title

Chief Financial Officer

Phone

(763) 586-5839

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• CPMG-Fridley Plaza Clinic Other name

Part of

Columbia Park CL Gen PR

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1336246735",
    "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": "6341 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554324946",
            "telephone_number": "763-572-5710",
            "fax_number": "763-586-5888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA PARK MEDICAL GROUP, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLUMBIA PARK MEDICAL GROUP, PA",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "CONDON",
        "authorized_official_first_name": "JOEN",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "763-586-5839"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA URGENT CARE",
            "identifier": "98-66093",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CT1003",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE URGENT CARE",
            "identifier": "UC0002",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CLINIC NUMBER",
            "identifier": "98-01409",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MN",
            "identifier": "104021",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "02071BR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "610",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CPMG-Fridley Plaza Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Brian Paul Cloutier
• Mekena Coakley, MS, LADC, LPCC
• Dale Lee Cody, M.D.
• Samantha Colombo, PHD
• Columbia Park Medical Group, PA
• Columbia Park Medical Group, PA
• Columbia Park Medical Group, PA
• Community Options Fridley Inc.
• Rory Matthew Connolly
• Zoe Copa, MSW, LICSW

• All providers in Fridley, MN
• Multi-Specialty Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.