Northeast Pediatric Clinic P.a.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

NORTHEAST PEDIATRIC CLINIC P.A.

Practice address

4520 Centerville Rd
Vadnais Heights, MN 55127-3602

Phone

(651) 426-1141

Fax

(651) 426-1705

NPI assigned

Nov 29, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Mary Ann Leukuma, M.D.

Title

Ceo

Phone

(651) 426-1141

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730162371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4520 CENTERVILLE RD",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551273602",
            "telephone_number": "651-426-1141",
            "fax_number": "651-426-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 CENTERVILLE RD",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551273602",
            "telephone_number": "651-426-1141",
            "fax_number": "651-426-1705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST PEDIATRIC CLINIC P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEUKUMA",
        "authorized_official_first_name": "MARY ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "651-426-1141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Robert Nicol, DPT
• Eric Stanton Niemyer, DPT
• Aaron C Nissen, PT, DPT
• Benjamin Todd Nivala, PT, DPT
• Jessica Norman, PHARMD
• Northern Lights Pediatric & Adolescent Medicine
• Novacare Outpatient Rehabilitation East Inc
• Carol Joan O'Sullivan, LICSW
• Andrew Charles Ockuly, DO
• Keith A Oelschlager, MD

• Primary Care Clinic/Center in Vadnais Heights, MN
• Providers in Vadnais Heights, MN by specialty
• Primary Care Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.