COLUMBIA PARK MEDICAL GROUP, PA (NPI# 1649370396) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649370396 |
| Entity Type | Organization |
| Organization Name | COLUMBIA PARK MEDICAL GROUP, PA |
| Other Organization Name | CPMG-BROOKLYN PARK PHARMACY |
| Practice Address |
10000 Zane Ave N Suite 100 Brooklyn Park MN 55443-1400 |
| Mailing Address |
6401 University Ave Ne Fridley MN 55432-4341 |
| Practice Telephone | 7635696281 |
| Practice Fax Number | 7635696211 |
| Mailing Telephone | 7635725710 |
| Mailing Fax Number | 7635713008 |
| Enumeration Date | 2006-09-23 |
| 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 |
262454-9 | MN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | MCKESSON | 831146 | 01 |
| MN | PHARMACY DEA NUMBER | BC8926404 | 01 |
| MN | NABP NUMBER | 2426220 | 01 |
| MN | BCBS DME NUMBER | 02071BR | 01 |
| MN | ANDA | 076751 | 01 |
| MN | IPC NUMBER | 10118513 | 01 |
| Other Name | Type Code |
|---|---|
| CPMG-Brooklyn Park 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 |
| 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 |
10000 ZANE AVE N SUITE 100 |
| City | BROOKLYN PARK |
| State | MN |
| Zip Code | 55443-1400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457330656 | Arvin Mangasi Vocal | Internal Medicine | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2006-01-16 |
| 1023548559 | Hilary G Wilde | Dietitian, Registered | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2017-06-18 |
| 1760928683 | Michelle Justen | Social Worker | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2017-01-17 |
| 1205389798 | Brianna Koopman | Registered Nurse | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2016-08-01 |
| 1356749907 | Rebecca Rathjen | Social Worker | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2014-12-15 |
| 1689080566 | Abass Ahmed Basha | Physician Assistant | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2014-07-11 |
| 1235419326 | Katerina O. Belousova | Physician Assistant | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2011-08-22 |
| 1629357918 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2011-08-04 |
| 1780973610 | Fairview Express Care | Clinic/Center | 10000 Zane Ave N, Ste 202, Brooklyn Park, MN 55443-1400 | 2011-03-31 |
| 1437469350 | Fairview Health Services | Clinic/Center | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2010-10-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770100521 | El-lyon LLC | Home Health | 5501 88th Crescent North, Brooklyn Park, MN 55443 | 2020-06-28 |
| 1003431628 | Mercy Tasiame Quentin | Home Health | 7310 Unity Lane North, Brooklyn Park, MN 55443 | 2020-06-09 |
| 1386279719 | Andrew Sirlley Dogbe | Nursing Care | 8505 Xerxes Ln N, Brooklyn Park, MN 55443 | 2020-03-05 |
| 1952873630 | Melkezedek Care LLC | Home Health | 8525 N Edinbrook Crossing Suite 204, Brooklyn Park, MN 55443 | 2018-12-19 |
| 1487131330 | Grand St Paul Cvs L L C | Durable Medical Equipment & Medical Supplies | 4400 Oak Grove Parkway, Brooklyn Park, MN 55443 | 2018-07-24 |
| 1063901809 | Patient Centered Home Care Services, LLC. | Registered Nurse | 4127 Sunset Ter N, Brooklyn Park, MN 55443 | 2018-05-08 |
| 1093233942 | Ginni Ali | Registered Nurse | 7527 Yates Lane North, Brooklyn Park, MN 55443 | 2017-08-30 |
| 1437676335 | Uplifted Care Services LLC | Case Management | 3301 84th Ave, Brooklyn Park, MN 55443 | 2017-08-23 |
| 1912447780 | Zillah Mulubisha | Nurse Practitioner | Brooklyn Park Clinic, 7650 Zane Ave N, Minneapolis, MN 55443 | 2017-02-27 |
| 1356898985 | Abdul Kabba | Driver | 79oo Lad Parkway, Brooklyn Park, MN 55443 | 2016-09-01 |
| Find all providers in zip 55443 | ||||
| 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 |
|---|---|---|---|---|
| 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 | ||||
| City | BROOKLYN PARK |
| Zip Code | 55443 |
Please comment or provide details below to improve the information on COLUMBIA PARK MEDICAL GROUP, PA.
| 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.