Basic Information
| Provider Information | |||||||||
| NPI: | 1851569909 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINNESOTA ONCOLOGY HEMATOLOGY, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6363 FRANCE AVE S | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529282900 | ||||||||
| FaxNumber: | 9529282944 | ||||||||
| Practice Location | |||||||||
| Address1: | 6363 FRANCE AVE S | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529282900 | ||||||||
| FaxNumber: | 9529282944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2008 | ||||||||
| LastUpdateDate: | 02/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | KATHRYN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. ADMINISTRATIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 6516025266 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 1076 | MN | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 364SA2200X | 1076 | MN | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health | 208G00000X | 1076 | MN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.