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Organization
CHILDREN'S HEALTH CARE
Active
Organization
CHILDREN'S HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA LU ALEXANDER MCCORMICK (SR. VP AND CHIEF FINANCIAL OFFICER)
(612) 813-6129
Entity
Organization
Contact information
Practice address
2525 CHICAGO AVE. S., MINNEAPOLIS, MN 55404-4518
(612) 813-6107
Mailing address
5901 LINCOLN DRIVE, CBC-2-REV/PE, EDINA, MN 55436-1611
(952) 992-5691
(952) 992-6917
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
338898
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C02022
MEDICARE
MN
Enumeration date
02/07/2008
Last updated
10/31/2022
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