Phoenix

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

PHOENIX

Doing business as

Phoenix

Practice address

6697 Elm St
North Branch, MN 55056-7045

Phone

(651) 795-8759

NPI assigned

Sep 11, 2020

Organization subpart

No

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

Authorized official

Name

Jeremy James Kortus

Title

Co-Founder

Phone

(651) 795-8759

Specialties & licenses 1

Addresses

Other names 1

• Phoenix Doing business as

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

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599782400000",
    "number": "1972118438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6697 ELM ST",
            "city": "NORTH BRANCH",
            "state": "MN",
            "postal_code": "550567045",
            "telephone_number": "651-795-8759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6697 ELM ST",
            "city": "NORTH BRANCH",
            "state": "MN",
            "postal_code": "550567045",
            "telephone_number": "651-795-8759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-11",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "KORTUS",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CO-FOUNDER",
        "authorized_official_telephone_number": "651-795-8759"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Briana Paige
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• Michael Bahr Perry
• Donald Richard Peters
• Phoenix Academy of Art and Science
• William C Piotrowski, MD
• Galen Pocta
• Progressive Living Solutions, Inc.
• Provide Care, Inc

• Voluntary or Charitable Agency in North Branch, MN
• Providers in North Branch, MN by specialty
• Voluntary or Charitable Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; 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.