NPIMap

Organization Active NPI

Columbia Park Medical Group, PA

  • Durable Medical Equipment & Medical Supplies
  • Andover, MN
National Provider Identifier
1942300801
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
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 22, 2006
Last updated
Nov 13, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
COLUMBIA PARK MEDICAL GROUP, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X MN Primary

Addresses

Primary practice location

13819 Hanson Blvd NW
Andover, MN 55304-7608

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
45Q12COOtherMNBCBS DME NUMBER

Other names 1

  • Andover Park Clinic - DME Other name

National Provider Directory

National Provider Directory
Tax ID family
Columbia Park Medical Group12 organizations share this tax ID, including this one
Part of
Columbia Park Medical Group

Other organizations with this tax ID 11

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

Locations

13819 Hanson Blvd NW
Andover, MN 55304
Phone (763) 572-5700

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1942300801",
    "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": "2006-09-22",
        "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS DME NUMBER",
            "identifier": "45Q12CO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Andover Park Clinic - DME",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Andover, MN

Sources for this page

  • 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.