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COLUMBIA PARK MEDICAL GROUP, PA

Ambulatory Health Care Facilities Clinic/Center Multi-Specialty

Provider NPI: 1215032743

Organization Information:
Organization Name:  COLUMBIA PARK MEDICAL GROUP, PA
Organization is Subpart
Authorized Official:  JOEN V CONDON  CHIEF FINANCIAL OFFICER  763-586-5839

Practice Location:
10000 ZANE AVE N  BROOKLYN PARK, MN 55443-1400 US
Tel: 763-572-5710  Fax: 763-569-6200

Business Mailing Address:
6401 UNIVERSITY AVE NE  FRIDLEY, MN 55432-4341 US
Tel: 763-572-5710  Fax: 763-571-3008

NPI Information:
NPI: 1215032743
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y261QM1300XAmbulatory Health Care Facilities
Clinic/Center
Multi-Specialty
MN

Other Provider Identifiers:

IssuerNumberStateType
UCARE MN104022MN01
MEDICARE RAILROADCT1003MN01
MEDICA URGENT CARE98-66164MN01
MEDICA CLINIC NUMBER98-01410MN01
HEALTHPARTNERS8477MN01
BCBS OF MN02071BRMN01
UCARE URGENT CAREUC0022MN01



American Medical Association 2012 taxonomy code information

Code: 261QM1300X

Type:

Classification:



Definition:



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