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Organization

COLUMBIA PARK MEDICAL GROUP, PA

Active
Parent organization
COLUMBIA PARK MEDICAL GROUP, PA
Other names
CPMG-Blaine Clinic
Organization subpart
Yes

Provider details

NPI number
Legal business name
COLUMBIA PARK MEDICAL GROUP, PA
Authorized official
JOEN V CONDON (CHIEF FINANCIAL OFFICER)
(763) 586-5839
Entity
Organization

Contact information

Practice address
10961 CLUB WEST PKWY, BLAINE, MN 55449-4671
(763) 572-5710
(763) 528-2945
Mailing address
6401 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4341
(763) 572-5710
(763) 571-3008

Taxonomy

Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
02071BR
BCBS OF MN
MN
01
181992
UCARE CLINIC NUMBER
MN
01
AQ909
PREFERRED ONE
MN
01
CT1003
MEDICARE RAILROAD
MN
01
UC0035
UCARE URGENT CARE
MN
Enumeration date
09/13/2006
Last updated
11/13/2007
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