Basic Information
| Provider Information | |||||||||
| NPI: | 1871780478 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 46100 | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554460100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635539920 | ||||||||
| FaxNumber: | 7635539910 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | WACONIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553871752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524427843 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2007 | ||||||||
| LastUpdateDate: | 10/02/2007 | ||||||||
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| AuthorizedOfficialLastName: | NIELSEN | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9524422191 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MHA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.