COLUMBIA PARK MEDICAL GROUP, PA (NPI# 1417056698) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417056698 |
| Entity Type | Organization |
| Organization Name | COLUMBIA PARK MEDICAL GROUP, PA |
| Other Organization Name | CPMG-ANDOVER PHARMACY |
| Practice Address |
13819 Hanson Blvd Nw Suite 100 Andover MN 55304-7608 |
| Mailing Address |
6401 University Ave Ne Fridley MN 55432-4341 |
| Practice Telephone | 7638624445 |
| Practice Fax Number | 7638624465 |
| Mailing Telephone | 7635725710 |
| Mailing Fax Number | 7635713008 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | JOHN LOUIS WEIR (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7635865877 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
261566-8 | MN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | NABP NUMBER | 24-22917 | 01 |
| MN | PHARMACY DEA NUMBER | BC6117938 | 01 |
| MN | IPC NUMBER | 10016952 | 01 |
| MN | ANDA | 306066 | 01 |
| MN | BCBS DME NUMBER | 45Q12CO | 01 |
| MN | MCKESSON | 314420 | 01 |
| Other Name | Type Code |
|---|---|
| CPMG-Andover Pharmacy | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497847644 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 10961 Club West Pkwy, Blaine, MN 55449-4671 | 2006-09-28 |
| 1558453787 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2006-09-28 |
| 1649370396 | Columbia Park Medical Group, Pa | Pharmacy | 10000 Zane Ave N, Suite 100, Brooklyn Park, MN 55443-1400 | 2006-09-23 |
| 1609976570 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 6341 University Ave Ne, Fridley, MN 55432-4946 | 2006-09-22 |
| 1942300801 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2006-09-22 |
| 1326148271 | Columbia Park Medical Group, Pa | Pharmacy | 4000 Central Ave Ne, Columbia Heights, MN 55421-2968 | 2006-09-22 |
| 1326147505 | Columbia Park Medical Group, Pa | Eyewear Supplier (Equipment, not the service) | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2006-09-22 |
| 1700986668 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 4000 Central Ave Ne, Columbia Heights, MN 55421-2968 | 2006-09-22 |
| 1619077575 | Columbia Park Medical Group, Pa | Eyewear Supplier (Equipment, not the service) | 4000 Central Ave Ne, Columbia Heights, MN 55421-2968 | 2006-09-22 |
| 1760589170 | Columbia Park Medical Group, Pa | Eyewear Supplier (Equipment, not the service) | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2006-09-20 |
| Street Address |
13819 HANSON BLVD NW SUITE 100 |
| City | ANDOVER |
| State | MN |
| Zip Code | 55304-7608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881656296 | David Robert Bachman | Family Medicine | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2006-04-03 |
| 1457820912 | Jason Emold Nesler | Physician Assistant | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2018-11-14 |
| 1861999195 | Chee Lor | Family Medicine | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2018-04-12 |
| 1073013181 | Stephanie Lynn Piche | Nurse Practitioner | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2018-02-15 |
| 1326402256 | Islam Zineldin | Family Medicine | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2016-04-06 |
| 1124487624 | Joseph Aaron Gray Wilkie | Physician Assistant | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2016-02-12 |
| 1063883338 | Kelly L Nguyen | Nurse Practitioner | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2015-10-13 |
| 1881017150 | Dana Thilges | Physician Assistant | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2014-01-22 |
| 1437581824 | Tiffany N Ling | Nurse Practitioner | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2013-08-07 |
| 1518244151 | Deborah Lynn Gerdes | Counselor | 13819 Hanson Blvd Nw, Andover, MN 55304 | 2011-11-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114402211 | Sarah Sue Anderson | Speech-Language Pathologist | 1891 Station Pkwy, Andover, MN 55304 | 2018-09-25 |
| 1306354329 | Jennifer Lynn Larkey I | Counselor | 1875 Station Parkway N.w. Andover, Mn 55304, Andover, MN 55304 | 2018-01-11 |
| 1124544895 | Msp Dentistry Inc | Preferred Provider Organization | 13650 Hanson Blvd., Suite #110, Andover, MN 55304 | 2017-08-15 |
| 1912427931 | Brooke Nicole Halliday | Counselor | 1875 Station Pkwy Ne, Andover, MN 55304 | 2017-06-21 |
| 1700286903 | Jari Welle, Inc. | Marriage & Family Therapist | 1328 Mckay Drive Ne, Suite 100, Ham Lake, MN 55304 | 2014-08-26 |
| 1356765192 | Cherrywood Advanced Living, LLC | Assisted Living Facility | 1889 139th Ave Nw, Andover, MN 55304 | 2014-02-14 |
| 1326462177 | Cherrywood Advanced Living, LLC | Assisted Living Facility | 1899 139th Ave Nw, Andover, MN 55304 | 2014-02-14 |
| 1740619568 | Delores Weikle | Physical Therapist | 14531 Jay St, Andover, MN 55304 | 2013-11-02 |
| 1730527003 | Darkou Care Services | Home Health | 14297 Zilla Street Nw, Andover, MN 55304 | 2013-06-10 |
| 1770927758 | Arbor Oaks Senior Living | Assisted Living Facility | 1640 155th Lane Nw, Andover, MN 55304 | 2013-04-22 |
| Find all providers in zip 55304 | ||||
| Taxonomy Code | 3336C0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Clinic Pharmacy |
| A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396866844 | Allina Health System | Pharmacy | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2007-04-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083138317 | Fairview Pharmacy Services LLC | Pharmacy | 17 Exchange St W Ste 150, Saint Paul, MN 55102-1045 | 2017-07-28 |
| 1760792691 | Goodrich Pharmacy Fridley | Pharmacy | 480 Osborne Rd Suite 180, Fridley, MN 55432 | 2010-10-13 |
| 1770719585 | Fairview Pharmacy Services LLC | Pharmacy | 14712 Victor Hugo Blvd N Ste 10, Hugo, MN 55038-6324 | 2009-06-08 |
| 1548400849 | Moka Pharmacy Inc | Pharmacy | 1515 E Franklin Ave, Minneapolis, MN 55404-2137 | 2009-02-26 |
| 1902012107 | Metro Treatment of Minnesota, Lp | Pharmacy | 14 E Central Entrance, Suite B, Duluth, MN 55811-5508 | 2007-05-15 |
| 1790909083 | Aitkin Community Hospital Inc. | Pharmacy | 27278 State Hwy 18, Garrison, MN 56450 | 2007-04-11 |
| 1437203882 | Shakopee Mdewakanton Sioux Comm Phcy | Pharmacy | 15045 Mystic Lake Dr Nw, Prior Lake, MN 55372-9011 | 2007-01-23 |
| 1407931553 | Waconia Pharmacy | Pharmacy | 430 Highway 5 West, Waconia, MN 55387-1795 | 2006-10-26 |
| 1548365406 | Mayo Foundation for Medical Education & Research | Pharmacy | 201 Center St W, Ste Lo92, Rochester, MN 55902-3003 | 2006-09-14 |
| 1407951353 | Mayo Foundation for Medical Education & Research | Pharmacy | 221 4th Ave Sw Ste 1116, Rochester, MN 55902-3110 | 2006-09-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.