NPIMap

Organization Active NPI

Pediatric Services PA

  • Clinic/Center
  • St Louis Park, MN
National Provider Identifier
1962553917
Registry record updated Mar 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
1056 Issued in MN
Legal business name
PEDIATRIC SERVICES PA
Practice address
4700 Park Glen Rd
St Louis Park, MN 55416-5701
Phone
(952) 922-4200
Fax
(952) 922-4301
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2016

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

Authorized official

Name
Jennifer Zerba
Title
Administrative Office Manager
Phone
(952) 922-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 1056 MN Primary

Addresses

Primary practice location

4700 Park Glen Rd
St Louis Park, MN 55416-5701

Mailing address

4700 Park Glen Rd
St Louis Park, MN 55416-5701
Phone (952) 922-4200

Other identifiers 1

IdentifierTypeStateIssuer
485010600MedicaidMN

National Provider Directory

National Provider Directory

Locations

5111 Minnetonka Blvd
St Louis Park, MN 55416
Phone (952) 922-4200

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457568000000",
    "number": "1962553917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 PARK GLEN RD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165701",
            "telephone_number": "952-922-4200",
            "fax_number": "952-922-4301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 PARK GLEN RD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165701",
            "telephone_number": "952-922-4200",
            "fax_number": "952-922-4301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SERVICES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2016-03-10",
        "status": "A",
        "authorized_official_last_name": "ZERBA",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATIVE OFFICE MANAGER",
        "authorized_official_telephone_number": "952-922-4200"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "1056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "485010600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; 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.