Basic Information
Provider Information
NPI: 1174581151
EntityType: 2
ReplacementNPI:  
OrganizationName: ALLINA HEALTH SYSTEM
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: UNITED HOSPITAL
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 43
Address2: MR 10202
City: MINNEAPOLIS
State: MN
PostalCode: 554070043
CountryCode: US
TelephoneNumber: 6122621166
FaxNumber:  
Practice Location
Address1: 333 SMITH AVE N
Address2:  
City: SAINT PAUL
State: MN
PostalCode: 551022344
CountryCode: US
TelephoneNumber: 6512418290
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/01/2006
LastUpdateDate: 01/09/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: CRIGER
AuthorizedOfficialFirstName: SARA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 7632368205
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
273Y00000X331673MNY Hospital UnitsRehabilitation Unit 

ID Information
IDTypeStateIssuerDescription
0100604801 PREFERREDONEOTHER
50-0319401 MEDICA CHOICEOTHER
28174710105MN MEDICAID
50-0003801 MEDICA SELECTCAREOTHER
1138HUN01 BCBS OF MNOTHER
2703801 HEALTHPARTNERSOTHER


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