NPIMap

Organization Active NPI

Columbia Park Medical Group, PA

  • Durable Medical Equipment & Medical Supplies
  • Blaine, MN
National Provider Identifier
1497847644
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
COLUMBIA PARK MEDICAL GROUP, PA
Practice address
10961 Club West Pkwy
Blaine, MN 55449-4671
Phone
(763) 572-5710
Fax
(763) 528-2945
NPI assigned
Sep 28, 2006
Organization subpart
Yes
Parent organization
COLUMBIA PARK MEDICAL GROUP, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X MN Primary

Addresses

Primary practice location

10961 Club West Pkwy
Blaine, MN 55449-4671

Mailing address

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

Other names 1

  • Blaine Clinic - DME Other name

National Provider Directory

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

Other organizations with this tax ID 11

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

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1497847644",
    "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": "10961 CLUB WEST PKWY",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494671",
            "telephone_number": "763-572-5710",
            "fax_number": "763-528-2945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA PARK MEDICAL GROUP, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLUMBIA PARK MEDICAL GROUP, PA",
        "enumeration_date": "2006-09-28",
        "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blaine Clinic - DME",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Blaine, MN

Sources for this page

  • 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.