Columbia Park Medical Group, PA

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

COLUMBIA PARK MEDICAL GROUP, PA

Practice address

13819 Hanson Blvd NW
Andover, MN 55304-7608

Phone

(763) 572-5710

Fax

(763) 862-4415

NPI assigned

Sep 13, 2006

Last updated

Nov 13, 2007By the provider in NPPES

Organization subpart

Yes

Parent organization

COLUMBIA PARK MEDICAL GROUP, PAAs reported in NPPES

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

Addresses

Other identifiers 7

Other names 1

• CPMG-Andover Park Clinic Other name

Part of

Fridley Plaza Clinic

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1639274160",
    "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": "13819 HANSON BLVD NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553047608",
            "telephone_number": "763-572-5710",
            "fax_number": "763-862-4415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA PARK MEDICAL GROUP, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLUMBIA PARK MEDICAL GROUP, PA",
        "enumeration_date": "2006-09-13",
        "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": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE URGENT CARE",
            "identifier": "UC0003",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CT1003",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "02071BR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MN",
            "identifier": "122190",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA URGENT CARE",
            "identifier": "98-66092",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA NUMBER",
            "identifier": "98-00470",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "54814",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CPMG-Andover Park Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Joy Hanna Cloutier, PHMNP
• Nicholas Coffield, LADC
• Maria Collins
• Columbia Park Medical Group, PA
• Columbia Park Medical Group, PA
• Columbia Park Medical Group, PA
• Gracie Isabella Comeau
• Community Services of Minnesota Inc
• Kristin Lynn Connell, OTR/L
• Conscious Healing Counseling Inc

• Multi-Specialty Clinic/Center in Andover, MN
• Providers in Andover, MN by specialty
• Multi-Specialty Clinic/Center in Minnesota

• 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.