BLOOMINGTON LAKE CLINIC LTD NPI 1215090501

NPI Information

NPI: 1215090501
Provider Name: BLOOMINGTON LAKE CLINIC, LTD
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 24D0881240

Address:
7901 XERXES AVE S STE 116
BLOOMINGTON, MN
ZIP 55431
Phone: (952) 888-2024
Get Directions

BLOOMINGTON LAKE CLINIC, LTD is a multi-specialty clinic center in Bloomington, MN. BLOOMINGTON LAKE CLINIC, LTD NPI is 1215090501. The provider is registered as an organization entity type.

The provider's business location address is:

7901 XERXES AVE S STE 116
BLOOMINGTON, MN
ZIP 55431-200
Phone: (952) 888-2024
Fax: (952) 888-3985

The provider's authorized official is Debra J Barger .
The authorized official title is Assistant Administrator and has the following contact phone number (612) 277-2165.

The CLIA number assigned to this NPI record is 24D0881240 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/18/2006 and was last updated on 4/4/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty	23	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1713	OTHER	MINNESOTA	HEALTH PARTNERS
2	C406	OTHER	MINNESOTA	UCARE MINNESOTA
3	C00001	MEDICARE ID-TYPE UNSPECIFIED	MINNESOTA
4	302510100	MEDICAID	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »