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Organization
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Active
Organization
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK NOLAN (CFO)
(651) 312-3105
Entity
Organization
Contact information
Practice address
200 UNIVERSITY AVE E, SAINT PAUL, MN 55101-2507
(651) 291-2848
(651) 325-2174
Mailing address
200 UNIVERSITY AVE E, SAINT PAUL, MN 55101-2507
(651) 291-2848
(651) 325-2174
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
273Y00000X
Rehabilitation Hospital Unit
—
MN
282NC2000X
Children's Hospital
Primary
—
—
284300000X
Special Hospital
—
—
332BC3200X
Customized Equipment (DME)
—
MN
335E00000X
Prosthetic/Orthotic Supplier
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0418080
—
MT
05
—
0520726
—
IA
05
—
11003700
—
WI
01
—
1111HGI
BLUE CROSS BLUE SHIELD
MN
01
—
2427462
PHARMACY-NCPDP
—
05
—
996047300
—
MN
Enumeration date
09/05/2006
Last updated
07/08/2020
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