Basic Information
| Provider Information | |||||||||
| NPI: | 1134751274 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPECIALIZED MEDICAL RESPONSE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LIVIO PALLIATIVE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 HARDING ST NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554132801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123987000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 HARDING ST NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554132801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123987000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2020 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | AKHTAR | ||||||||
| AuthorizedOfficialFirstName: | SYED | ||||||||
| AuthorizedOfficialMiddleName: | SUMAIR | ||||||||
| AuthorizedOfficialTitleorPosition: | VP & CHIEF CLINICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6123987131 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SPECIALIZED MEDICAL RESPONSE, LLC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No ID Information.