COLUMBIA PARK MEDICAL GROUP, PA (NPI# 1639274160) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639274160 |
| Entity Type | Organization |
| Organization Name | COLUMBIA PARK MEDICAL GROUP, PA |
| Other Organization Name | CPMG-ANDOVER PARK CLINIC |
| Practice Address |
13819 Hanson Blvd Nw Andover MN 55304-7608 |
| Mailing Address |
6401 University Ave Ne Fridley MN 55432-4341 |
| Practice Telephone | 7635725710 |
| Practice Fax Number | 7638624415 |
| Mailing Telephone | 7635725710 |
| Mailing Fax Number | 7635713008 |
| Enumeration Date | 2006-09-13 |
| 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 | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
MN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BCBS | 02071BR | 01 |
| MN | HEALTHPARTNERS | 54814 | 01 |
| MN | UCARE URGENT CARE | UC0003 | 01 |
| MN | MEDICA URGENT CARE | 98-66092 | 01 |
| MN | MEDICA NUMBER | 98-00470 | 01 |
| MN | MEDICARE RAILROAD | CT1003 | 01 |
| MN | UCARE MN | 122190 | 01 |
| Other Name | Type Code |
|---|---|
| CPMG-Andover Park Clinic | 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 |
| 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 |
| Street Address |
13819 HANSON BLVD NW |
| 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 | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477734705 | Fairview Clinics | Clinic/Center | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2007-11-15 |
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| 1730731464 | St Marys Regional Health Center | Clinic/Center | 1103 1st St E, Park Rapids, MN 56470 | 2019-07-12 |
| 1003478892 | The Duluth Clinic Ltd | Clinic/Center | 4289 Ugstad Rd, Hermantown, MN 55811-3615 | 2019-07-02 |
| 1073005856 | Arbor Integrative Behavioral Health | Clinic/Center | 1000 E 1st St Ste 105, Duluth, MN 55805-2297 | 2018-06-06 |
| 1689161077 | Chs Tennessee Medical P C | Clinic/Center | 701 Brooks Ave S, Thief River Falls, MN 56701-2757 | 2018-04-20 |
| 1427557867 | Gillette Children's Specialty Healthcare | Clinic/Center | 505 Paul Bunyan Dr Nw, Bemidji, MN 56601-2400 | 2018-02-11 |
| 1992224331 | Orthopedic & Sports Physical Therapy, Inc. | Clinic/Center | 322 N Tower Rd, Fergus Falls, MN 56537-1015 | 2017-09-18 |
| 1003339789 | Centracare Clinic | Clinic/Center | 2025 Stearns Way Ste 114, Saint Cloud, MN 56303 | 2017-07-25 |
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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.