NPIMap

Organization Active NPI

Good Clinic MN PLLC

  • Non-Pharmacy Dispensing Site
  • Minneapolis, MN
National Provider Identifier
1962097683
Registry record updated Mar 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
GOOD CLINIC MN PLLC
Practice address
307 1St Avenue
Minneapolis, MN 55413-0000
Phone
(952) 653-2525
Fax
(952) 653-2540
NPI assigned
Mar 4, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2021

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

Authorized official

Name
Rebecca Hafner-Fogarty, MD
Title
Authorized Official
Phone
(612) 284-8206

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

307 1St Avenue
Minneapolis, MN 55413-0000

Mailing address

307 1St Avenue
Minneapolis, MN 55413
Phone (952) 653-2525

National Provider Directory

National Provider Directory

Locations

307 1st Ave NE
Minneapolis, MN 55413
Phone (612) 284-8206

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1962097683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 1ST AVENUE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55413",
            "telephone_number": "952-653-2525",
            "fax_number": "952-653-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 1ST AVENUE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554130000",
            "telephone_number": "952-653-2525",
            "fax_number": "952-653-2540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD CLINIC MN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-04",
        "last_updated": "2021-03-04",
        "certification_date": "2021-02-11",
        "status": "A",
        "authorized_official_last_name": "HAFNER-FOGARTY",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "612-284-8206",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; 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.