Minnesota Head and Neck Pain Clinic, PA

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

MINNESOTA HEAD AND NECK PAIN CLINIC, PA

Practice address

3475 Plymouth Blvd
Suite 200
Plymouth, MN 55447-1499

Phone

(763) 577-2484

Fax

(763) 577-1375

NPI assigned

Jun 29, 2015

Organization subpart

No

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

Authorized official

Name

Tia A Reichert

Title

Chro/Clinic Administrator

Phone

(763) 577-2484

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Minnesota Head and Neck Pain Clinic, PA

  • Specialist
  • St Paul, MN
  • NPI 1104850155

  2769453687

  Same PAC ID
• Minnesota Head and Neck Pain Clinic, PA

  • Specialist
  • Burnsville, MN
  • NPI 1255715181

  2769453687

  Same PAC ID
• Minnesota Head and Neck Pain Clinic, PA

  • Orofacial Pain Dentistry
  • Woodbury, MN
  • NPI 1710854369

  2769453687

  Same PAC ID

Tax ID family

Minnesota Head Neck Pain5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

• Minnesota Head and Neck Pain Clinic, PA

  • Orofacial Pain Dentistry
  • Saint Cloud, MN
  • NPI 1003316852
  NPD tax ID
• Minnesota Head and Neck Pain Clinic, PA

  • Specialist
  • St Paul, MN
  • NPI 1104850155
  NPD tax ID
• Minnesota Head and Neck Pain Clinic, PA

  • Specialist
  • Burnsville, MN
  • NPI 1255715181
  NPD tax ID
• Minnesota Head and Neck Pain Clinic, PA

  • Orofacial Pain Dentistry
  • Woodbury, MN
  • NPI 1710854369
  NPD tax ID

Locations

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

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1871975607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3475 PLYMOUTH BLVD",
            "address_2": "SUITE 200",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554471499",
            "telephone_number": "763-577-2484",
            "fax_number": "763-577-1375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3475 PLYMOUTH BLVD",
            "address_2": "SUITE 200",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554471499",
            "telephone_number": "763-577-2484",
            "fax_number": "763-577-1375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA HEAD AND NECK PAIN CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-29",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "REICHERT",
        "authorized_official_first_name": "TIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHRO/CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "763-577-2484"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel James Miller, DPT
• Taishawn Miller, MS, BT
• Mindfully Well LLC
• Natalie Mingo, CRNA
• Minneapolis Vascular Physicians
• Minnesota Life Care Services
• Minnesota Maxillofacial and Oral Consultants
• Minnesota Oncology Hematology PA
• Minnesota Oral & Maxillofacial Surgery, P.a.
• Minnesota Orthodontics and Dentofacial Orthopedics PA

• Specialist in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.