Basic Information
| Provider Information | |||||||||
| NPI: | 1164486445 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLINA HEALTH SYSTEM | ||||||||
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| OtherOrganizationName: | ALLINA HEALTH HOME OXYGEN & MEDICAL EQUIPMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2925 CHICAGO AVE | ||||||||
| Address2: | MR 10809 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122624867 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1055 WESTGATE DR STE 140 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551141451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516284800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | CRIST | ||||||||
| AuthorizedOfficialFirstName: | JULIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 6122627213 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 69678 | 01 | HEALTHPARTNERS | OTHER | 82-00049 | 01 | MEDICA SELECTCARE | OTHER | 26699ME | 01 | MN | BCBS OF MN | OTHER | 627612100 | 05 | MN | MEDICAID | 0000700 | 01 | PREFERREDONE | OTHER | 82-15617 | 01 | MEDICA CHOICE | OTHER |