NPIMap

Organization Active NPI

Columbia Park Medical Group, PA

  • Clinic Pharmacy
  • Brooklyn Park, MN
National Provider Identifier
1649370396
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
262454-9 Issued in MN
Legal business name
COLUMBIA PARK MEDICAL GROUP, PA
Practice address
10000 Zane Ave N
Suite 100
Brooklyn Park, MN 55443-1400
Phone
(763) 569-6281
Fax
(763) 569-6211
NPI assigned
Sep 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
John Louis Weir
Title
Executive Director
Phone
(763) 586-5877

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 262454-9 MN Primary

Addresses

Primary practice location

10000 Zane Ave N
Suite 100
Brooklyn Park, MN 55443-1400

Mailing address

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

Other identifiers 5

IdentifierTypeStateIssuer
10118513OtherMNIPC NUMBER
076751OtherMNANDA
831146OtherMNMCKESSON
2426220OtherMNNABP NUMBER
02071BROtherMNBCBS DME NUMBER

Other names 1

  • CPMG-Brooklyn Park Pharmacy Other name

National Provider Directory

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

Other organizations with this tax ID 11

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

Locations

10000 Zane Ave N
Ste 100
Brooklyn Park, MN 55443
Phone (763) 569-6281

NPI Registry JSON

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1649370396",
    "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": "10000 ZANE AVE N",
            "address_2": "SUITE 100",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554431400",
            "telephone_number": "763-569-6281",
            "fax_number": "763-569-6211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA PARK MEDICAL GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-23",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "WEIR",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "763-586-5877"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "MN",
            "license": "262454-9",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IPC NUMBER",
            "identifier": "10118513",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANDA",
            "identifier": "076751",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCKESSON",
            "identifier": "831146",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "2426220",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS DME NUMBER",
            "identifier": "02071BR",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CPMG-Brooklyn Park Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Brooklyn Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.