Organization
COLUMBIA PARK MEDICAL GROUP, PA
Active
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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