COLUMBIA PARK MEDICAL GROUP, PA (NPI# 1497847644) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497847644 |
| Entity Type | Organization |
| Organization Name | COLUMBIA PARK MEDICAL GROUP, PA |
| Other Organization Name | BLAINE CLINIC - DME |
| Practice Address |
10961 Club West Pkwy Blaine MN 55449-4671 |
| Mailing Address |
6401 University Ave Ne Fridley MN 55432-4341 |
| Practice Telephone | 7635725710 |
| Practice Fax Number | 7635282945 |
| Mailing Telephone | 7635725710 |
| Mailing Fax Number | 7635713008 |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-11-13 |
| Authorized Official Name | JOEN V CONDON (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 7635865839 |
| Is Organization Subpart | Y |
| Parent Organization Name | COLUMBIA PARK MEDICAL GROUP, PA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | MN | Suppliers |
| Other Name | Type Code |
|---|---|
| Blaine Clinic - DME | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1417056698 | Columbia Park Medical Group, Pa | Pharmacy | 13819 Hanson Blvd Nw, Suite 100, Andover, MN 55304-7608 | 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 |
10961 CLUB WEST PKWY |
| City | BLAINE |
| State | MN |
| Zip Code | 55449-4671 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447205810 | Mary Bhavsar | Ophthalmology | 10961 Club West Pkwy, Suite 130, Blaine, MN 55449-5866 | 2006-05-24 |
| 1437774957 | Brian J Helmrick | Specialist/Technologist | 10961 Club West Pkwy, Blaine, MN 55449-5866 | 2020-06-10 |
| 1912364134 | Fairview Health Services | Clinic/Center | 10961 Club West Pkwy, Blaine, MN 55449-5866 | 2016-01-19 |
| 1528466372 | Carissa Fleek | Specialist/Technologist | 10961 Club West Pkwy, Blaine, MN 55449-5866 | 2014-12-10 |
| 1740683192 | Ann Studniski | Specialist/Technologist | 10961 Club West Pkwy, Suite 200, Blaine, MN 55449-5866 | 2014-09-30 |
| 1366855629 | Charles Joseph Kopp | Optometrist | 10961 Club West Pkwy, Suite 130, Blaine, MN 55449-5866 | 2014-06-04 |
| 1912332271 | Tec LLC | Eyewear Supplier (Equipment, not the service) | 10961 Club West Pkwy, Suite 130, Blaine, MN 55449-5866 | 2013-09-05 |
| 1831456953 | Jonathan Raphael Snitzer | Anesthesiology | 10961 Club West Pkwy, Blaine, MN 55449-5866 | 2012-04-13 |
| 1780962381 | Andrea Lewis | Physical Therapist | 10961 Club West Pkwy, Blaine, MN 55449-5866 | 2011-07-30 |
| 1114210036 | Joseph Miles Palmquist | Physician Assistant | 10961 Club West Pkwy, Blaine, MN 55449-5866 | 2011-05-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033736368 | Landon Thomas Case | Dentist | 10729 Town Square Drive Ne, Ste 100, Blaine, MN 55449 | 2020-07-02 |
| 1881168441 | Ear Institutes, LLC | Otolaryngology | 4365 Pleasant Ridge Dr Ne, Suite 106, Blaine, MN 55449 | 2019-01-17 |
| 1841776242 | Kristin Broback | Nurse Practitioner | 10705 Town Square Dr Ne #100, Blaine, MN 55449 | 2018-07-18 |
| 1043719016 | Robin Lynn Broen | Registered Nurse | 3012 129th Ave Ne, Blaine, MN 55449 | 2018-02-06 |
| 1194197368 | Lund Health Professional Corporation | Chiropractor | 1360 101st Ave Ne, Suite 140, Blaine, MN 55449 | 2015-10-27 |
| 1871989806 | Blaine Wp II, LLC | Assisted Living Facility | 12402 Jamestown Street Ne, Blaine, MN 55449 | 2015-04-07 |
| 1154761633 | Jean Budge | Marriage & Family Therapist | 11800 Aberdeen Street Ne, Suite 100, Blaine, MN 55449 | 2013-06-28 |
| 1295013498 | Jeff K Yu | Veterinarian | 11850 Aberdeen St Ne, Blaine, MN 55449 | 2011-07-22 |
| 1528394707 | Julie Ann Eibensteiner | Physical Therapist | 11304 Davenport Circle Ne #a, Minneapolis, MN 55449 | 2009-10-23 |
| 1871725333 | Deborah Kathryn Zongo | Nurse Practitioner | 10190 Baltimore St Ne Ste 100, Blaine, MN 55449 | 2009-08-18 |
| Find all providers in zip 55449 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235681958 | Supervalu Pharmacies Inc | Durable Medical Equipment & Medical Supplies | 10881 University Ave Ne, Blaine, MN 55434 | 2016-10-28 |
| 1205273984 | Walmart Inc. | Durable Medical Equipment & Medical Supplies | 11505 Ulysses St Ne, Blaine, MN 55434-4239 | 2013-06-04 |
| 1952603862 | Wellness Diabetes Care LLC | Durable Medical Equipment & Medical Supplies | 11005 Tyler St Ne, Blaine, MN 55434-4535 | 2010-11-29 |
| 1255574430 | Superior Medical Services Inc | Durable Medical Equipment & Medical Supplies | 10995 Club West Pkwy, Suite 500, Blaine, MN 55449-5058 | 2009-04-17 |
| 1750566287 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 10905 Ulysses St Ne, Blaine, MN 55434-3827 | 2008-01-03 |
| 1093824302 | Thrifty Payless Inc | Durable Medical Equipment & Medical Supplies | 1195 Boblett Street, Blaine, WA 98230-5157 | 2006-08-30 |
| 1043326457 | Supervalu Pharmacies Inc | Durable Medical Equipment & Medical Supplies | 12595 Central Ave Ne, Blaine, MN 55434 | 2006-08-21 |
| 1225143365 | Supervalu Pharmacies Inc | Durable Medical Equipment & Medical Supplies | 585 Northtown Dr Ne, Blaine, MN 55434 | 2006-08-20 |
| 1649385782 | Supervalu Pharmacies Inc | Durable Medical Equipment & Medical Supplies | 4205 Pheasant Ridge Dr Ne, Blaine, MN 55449-4529 | 2006-08-20 |
| 1124033352 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 600 County Road 10 Ne, Blaine, MN 55434-2329 | 2006-07-29 |
| Find all providers in BLAINE | ||||
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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.