Basic Information
| Provider Information | |||||||||
| NPI: | 1366751521 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNITED HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 SMITH AVE N | ||||||||
| Address2: | MAIL ROUTE 660104 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512418290 | ||||||||
| FaxNumber: | 6512417177 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 SMITH AVE N | ||||||||
| Address2: | MAIL ROUTE 660104 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512418290 | ||||||||
| FaxNumber: | 6512417177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 10/05/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARLSON | ||||||||
| AuthorizedOfficialFirstName: | TREVOR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | REHAB SERVICES LEADER | ||||||||
| AuthorizedOfficialTelephone: | 6512418290 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PHYSICAL THERAPIST | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 8594 | MN | Y | Hospitals | General Acute Care Hospital |
No ID Information.