MEDICAL ADDICTION TREATMENT CLINIC NPI 1891031209

NPI Information

NPI: 1891031209
Provider Name: MEDICAL ADDICTION TREATMENT CLINIC

Doing Business As: SAGE PRAIRIE

Classification: Internal Medicine - 207RA0401X
Entity Type: Organization

Specialization: Addiction Medicine

Address:
3805 WASHINGTON AVE N
MINNEAPOLIS, MN
ZIP 55412
Phone: (612) 887-6282
Get Directions

MEDICAL ADDICTION TREATMENT CLINIC is an addiction medicine internal medicine in Minneapolis, MN. The provider is an internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. MEDICAL ADDICTION TREATMENT CLINIC NPI is 1891031209. The provider is registered as an organization entity type.
The provider Is Doing Business As Sage Prairie.

The provider's business location address is:

3805 WASHINGTON AVE N
MINNEAPOLIS, MN
ZIP 55412-141
Phone: (612) 887-6282
Fax: (612) 437-4992

The provider's authorized official is Anne M Pylkas .
The authorized official title is Ceo and has the following contact phone number (612) 435-7380.

The enumeration date for this NPI number is 12/13/2012 and was last updated on 8/17/2022.

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	261Q00000X	Clinic/Center				No
2	363AM0700X	Physician Assistant	Medical	12684	MINNESOTA	No
3	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health			No
4	207RA0401X	Internal Medicine	Addiction Medicine	52519	MINNESOTA	Yes

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: 5/5/2024

NPI Synchronization or Removal

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