Northside Resource, Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

NORTHSIDE RESOURCE, INC.

Practice address

526 121St Ave NE
Blaine, MN 55434-3380

Phone

(612) 709-1440

NPI assigned

Dec 1, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Abshir Mohamed

Title

Owner

Phone

(612) 709-1440

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1417392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435536000000",
    "number": "1346647773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2733 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 121ST AVE NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554343380",
            "telephone_number": "612-709-1440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE RESOURCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-01",
        "last_updated": "2015-06-29",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "ABSHIR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-709-1440",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "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 Jun 29, 2015; 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.