Active NPI
Park Nicollet Health Care Products
- Durable Medical Equipment & Medical Supplies
- Brooklyn Center, MN
National Provider Identifier
1518929017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Legal business name
- PARK NICOLLET HEALTH CARE PRODUCTS
- Practice address
- 6000 Earle Brown Dr
Brooklyn Center, MN 55430-2506 - Phone
- (952) 993-4801
- NPI assigned
- Apr 3, 2006
- Reactivated
- Feb 20, 2025
- Organization subpart
- Yes
- Parent organization
- PARK NICOLLET HEALTH SERVICES
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Catherine F Lenagh
- Title
- Cfo
- Phone
- (952) 993-3108
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Primary | ||
| Eyewear Supplier | 332H00000X | |||
| Clinic Pharmacy | 3336C0002X | MN |
Addresses
Primary practice location
6000 Earle Brown Dr
Brooklyn Center, MN 55430-2506
Mailing address
3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21398500 | Medicaid | MN | |
| 2419655 | Other | NCPDP PROVIDER INDENTIFICAITON NUMBER |
National Provider Directory
National Provider Directory- Part of
- Park Nicollet
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144022400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1740009600000",
"number": "1518929017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3800 PARK NICOLLET BLVD",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554162527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6000 EARLE BROWN DR",
"city": "BROOKLYN CENTER",
"state": "MN",
"postal_code": "554302506",
"telephone_number": "952-993-4801"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PARK NICOLLET HEALTH CARE PRODUCTS",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PARK NICOLLET HEALTH SERVICES",
"enumeration_date": "2006-04-03",
"last_updated": "2025-02-20",
"deactivation_date": "2025-01-24",
"reactivation_date": "2025-02-20",
"status": "A",
"authorized_official_last_name": "LENAGH",
"authorized_official_first_name": "CATHERINE",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "952-993-3108"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": true
},
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0002X",
"taxonomy_group": "",
"desc": "Pharmacy, Clinic Pharmacy",
"state": "MN",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "21398500",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP PROVIDER INDENTIFICAITON NUMBER",
"identifier": "2419655",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn Center, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.