FRIDLEY TARGET CLINIC (NPI# 1457437907) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457437907 |
| Entity Type | Organization |
| Organization Name | FRIDLEY TARGET CLINIC |
| Practice Address |
755 53rd Ave Ne Fridley MN 55421-1240 |
| Mailing Address |
12375 Oak Park Blvd Ne Apt # 206 Blaine MN 55434-7302 |
| Practice Telephone | 7635719361 |
| Mailing Telephone | 7638629656 |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. MILLICENT WANJOHI (PHYSICIAN ASSISTANT) |
| Authorized Official Telephone | 7635719361 |
| Authorized Official Credential | PA-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
935 | MN | Ambulatory Health Care Facilities |
| Street Address |
755 53RD AVE NE |
| City | FRIDLEY |
| State | MN |
| Zip Code | 55421-1240 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497757470 | Marguerite Nancy Kibira | Physician Assistant | 755 53rd Ave Ne, Fridley, MN 55421-1240 | 2005-08-10 |
| 1326662149 | Naomi Mehn Ngaima | Pharmacist | 755 53rd Ave Ne, Fridley, MN 55421-1240 | 2020-06-08 |
| 1356789952 | Rachael Moberg | Physician Assistant | 755 53rd Ave Ne, Cvs Minute Clinic, Fridley, MN 55421-1240 | 2013-06-05 |
| 1821346750 | Katrina Marie Sacchetti | Pharmacist | 755 53rd Ave Ne, Fridley, MN 55421-1240 | 2012-08-27 |
| 1457647638 | Melisa Dawn Darling | Pharmacist | 755 53rd Ave Ne, T-2200, Fridley, MN 55421-1240 | 2011-06-25 |
| 1043504889 | William S Johnson | Pharmacist | 755 53rd Ave Ne, Fridley, MN 55421-1240 | 2011-06-08 |
| 1215221072 | Jennifer Ann Brummer | Pharmacist | 755 53rd Ave Ne, Fridley, MN 55421-1240 | 2011-06-08 |
| 1578755088 | Chad Michael Legois | Optometrist | 755 53rd Ave Ne, Fridley, MN 55421-1240 | 2007-08-17 |
| 1083743892 | Millicent Wanjohi | Physician Assistant | 755 53rd Ave Ne, Fridley, MN 55421-1240 | 2007-03-05 |
| 1023156874 | Janet Gay Flanagan | Physician Assistant | 755 53rd Ave Ne, Fridley, MN 55421-1240 | 2007-02-02 |
| Find all providers in the same location | ||||
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|---|---|---|---|---|
| 1982241782 | Cc Group Home Care Inc | Non-emergency Medical Transport (VAN) | 524 Huset Pkwy Ne, Columbia Heights, MN 55421 | 2019-11-30 |
| 1710455324 | Victoria F Renner | Physical Therapist | 4512, 3700 Foss Rd, Minneapolis, MN 55421 | 2018-11-13 |
| 1245721976 | Complete Care Home Care LLC | Home Health | 4111 Central Ave Ne North Building, Suite 202, Columbia Heights, MN 55421 | 2018-05-29 |
| 1053816389 | Anoka Health Center LLC | Clinic/Center | 4111 Central Ave N.e, Suite 201 North Building, Columbia Heights, MN 55421 | 2018-03-28 |
| 1508381047 | Minnesota Home Health Care LLC | Home Health | 534 Huset Parkway, Columbia Heights, MN 55421 | 2017-08-05 |
| 1720520448 | Tesfa International School | Local Education Agency (LEA) | 1550 40th Avenue Northeast, Columbia Heights, MN 55421 | 2016-11-11 |
| 1487012548 | Icare Transportation | Non-emergency Medical Transport (VAN) | 2816 Silver Ln Ne #305, Saint Anthony, MN 55421 | 2016-02-04 |
| 1194183368 | Warsame Warsame | Non-emergency Medical Transport (VAN) | 1115 45th Ave Ne, Columbia Heights, MN 55421 | 2016-02-03 |
| 1083083398 | Epic Transportation LLC | Clinic/Center | 355 Orendorff Way Ne, Columbia Heights, MN 55421 | 2015-09-16 |
| 1508281023 | Alexandra Marie Hodson | Occupational Therapist | 5155 E. River Rd, Suite #403, Fridley, MN 55421 | 2014-02-20 |
| Find all providers in zip 55421 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407389364 | Neopath | Clinic/Center | 5130 Main St Ne, Fridley, MN 55421-1528 | 2017-04-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003423252 | Good Clinic Mn Pllc | Clinic/Center | 315 1st Ave Ne, Minneapolis, MN 55413-5001 | 2020-09-30 |
| 1407496219 | Hope Health Initiative | Clinic/Center | 6818 Humboldt Ave N, Brooklyn Center, MN 55430-1536 | 2020-01-09 |
| 1902392525 | Odam Medical Group | Clinic/Center | 3405 3rd St N, Saint Cloud, MN 56303-4015 | 2018-07-06 |
| 1376041822 | Piic Clinical Services | Clinic/Center | 6500 Humboldt Ave N, Brooklyn Center, MN 55430-1800 | 2018-01-30 |
| 1760905475 | Patient Centered Care | Clinic/Center | 8240 Hampshire Ct N, Brooklyn Park, MN 55445 | 2017-07-25 |
| 1740703339 | Neopath | Clinic/Center | 119 30th Ave W Ste 119, Alexandria, MN 56308-3433 | 2017-07-25 |
| 1720500309 | Centracare Clinic | Clinic/Center | 2749 Sexton Drive, Mary Hall - Room 001, Collegeville, MN 56321 | 2017-07-14 |
| 1881116747 | Centracare Clinic | Clinic/Center | 402 Red River Ave N Ste 2, Cold Spring, MN 56320-1523 | 2017-07-12 |
| 1558898387 | Centracare Clinic | Clinic/Center | 161 Glen St., Ste 101, Foley, MN 56329 | 2017-05-11 |
| 1164958104 | Centracare Clinic | Clinic/Center | 113 Waite Ave S Ste 101, Waite Park, MN 56387-1348 | 2017-05-11 |
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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.