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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