NPIMap

Organization Active NPI

Health Source of Woodbury PA

  • Clinic/Center
  • Woodbury, MN
National Provider Identifier
1447401971
Registry record updated Oct 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
HEALTH SOURCE OF WOODBURY PA
Practice address
7060 Valley Creek PLZ Ste 121
Woodbury, MN 55125-2269
Phone
(651) 735-8646
NPI assigned
Oct 2, 2008
Last updated
Oct 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2008

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

Authorized official

Name
Dr. Jeffrey J. Wisdo, D.C.NPI 1124060017
Title
Owner
Phone
(651) 735-8646

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
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

7060 Valley Creek PLZ Ste 121
Woodbury, MN 55125-2269

Mailing address

7060 Valley Creek PLZ Ste 121
Woodbury, MN 55125-2269
Phone (651) 735-8646

National Provider Directory

National Provider Directory

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": "1222905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222905600000",
    "number": "1447401971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7060 VALLEY CREEK PLZ STE 121",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252269",
            "telephone_number": "651-735-8646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7060 VALLEY CREEK PLZ STE 121",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252269",
            "telephone_number": "651-735-8646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH SOURCE OF WOODBURY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-02",
        "last_updated": "2008-10-02",
        "status": "A",
        "authorized_official_last_name": "WISDO",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-735-8646",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2008; 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.