NPIMap

Organization Active NPI

Grand Itasca Clinic and Hospital

Doing business as Grand Itasca Pharmacy

  • Pharmacy
  • Grand Rapids, MN
National Provider Identifier
1902379159
Registry record updated Jan 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
GRAND ITASCA CLINIC AND HOSPITAL
Doing business as
Grand Itasca Pharmacy
Practice address
1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone
(218) 999-1885
Fax
(218) 999-1887
NPI assigned
Jan 9, 2019
Last updated
Jan 9, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
GRAND ITASCA CLINIC & HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 9, 2019

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

Authorized official

Name
Jean Macdonell
Title
VP, Clinic Services
Phone
(218) 999-1510

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU Primary

Addresses

Primary practice location

1601 Golf Course Rd
Grand Rapids, MN 55744-8648

Mailing address

1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone (218) 999-1885

Other identifiers 1

IdentifierTypeStateIssuer
288995200MedicaidMN

Other names 1

  • Grand Itasca Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Grand Itasca Clinic and Hospital3 organizations share this tax ID, including this one
Part of
Grand Itasca Clinic and Hospital

Other organizations with this tax ID 2

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

Locations

1601 Golf Course Rd
Grand Rapids, MN 55744
Phone (218) 326-3401

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1546992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546992000000",
    "number": "1902379159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 GOLF COURSE RD",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557448648",
            "telephone_number": "218-999-1885",
            "fax_number": "218-999-1887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 GOLF COURSE RD",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557448648",
            "telephone_number": "218-999-1885",
            "fax_number": "218-999-1887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND ITASCA CLINIC AND HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRAND ITASCA CLINIC & HOSPITAL",
        "enumeration_date": "2019-01-09",
        "last_updated": "2019-01-09",
        "status": "A",
        "authorized_official_last_name": "MACDONELL",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "VP, CLINIC SERVICES",
        "authorized_official_telephone_number": "218-999-1510"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288995200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Itasca Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; 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.