Organization
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Active
Parent organization
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Other names
Gillette Children's Healthcare MNTK
Organization subpart
Yes
Provider details
NPI number
Legal business name
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Authorized official
PATRICK NOLAN (CFO)
(651) 312-3105
Entity
Organization
Contact information
Practice address
6060 CLEARWATER DR, MINNETONKA, MN 55343-9442
(952) 936-0977
(952) 936-0944
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
Primary
—
MN
332B00000X
Durable Medical Equipment & Medical Supplies
—
MN
332BC3200X
Customized Equipment (DME)
—
MN
335E00000X
Prosthetic/Orthotic Supplier
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11003700
—
WI
01
—
1111HGI
BLUE CROSS BLUE SHIELD
—
05
—
41683100
—
WI
05
—
594130000
—
MN
05
—
815488000
—
MN
Enumeration date
12/06/2006
Last updated
12/13/2019
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