NPIMap

Organization Active NPI

Avanti Medical Group of Minnesota LLC

  • Clinic/Center
  • Stillwater, MN
National Provider Identifier
1578872974
Registry record updated Oct 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
AVANTI MEDICAL GROUP OF MINNESOTA LLC
Practice address
1801 Market Dr
Stillwater, MN 55082-7599
Phone
(318) 465-5874
NPI assigned
Oct 2, 2010
Last updated
Oct 2, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
AVANTI MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2010

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

Authorized official

Name
Amy Graham, RN, BSN
Title
Vice President Medical Affairs
Phone
(318) 465-5874

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

1801 Market Dr
Stillwater, MN 55082-7599

Mailing address

1755 S Naperville Rd
Suite 100
Wheaton, IL 60189-5844
Phone (318) 465-5874

National Provider Directory

National Provider Directory
Tax ID family
Avanti Medical Group of Minnesota LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1285977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285977600000",
    "number": "1578872974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1755 S NAPERVILLE RD",
            "address_2": "SUITE 100",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601895844",
            "telephone_number": "318-465-5874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 MARKET DR",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550827599",
            "telephone_number": "318-465-5874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANTI MEDICAL GROUP OF MINNESOTA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVANTI MEDICAL GROUP",
        "enumeration_date": "2010-10-02",
        "last_updated": "2010-10-02",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "VICE PRESIDENT MEDICAL AFFAIRS",
        "authorized_official_telephone_number": "318-465-5874",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2010; 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.