Basic Information
| Provider Information | |||||||||
| NPI: | 1790354496 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECIALIZED MEDICAL RESPONSE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 HARDING ST NE STE 100 | ||||||||
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| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554132801 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 401 HARDING ST NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554132801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123987000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2021 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | NAIR | ||||||||
| AuthorizedOfficialFirstName: | KAVITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6123987047 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SPECIALIZED MEDICAL RESPONSE LLC | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.