ETHAN CONROY PAC NPI 1023089547

NPI Information

  • NPI: 1023089547
  • Provider Name: ETHAN CONROY, PAC
  • Classification: Physician Assistant - 363AS0400X
  • Specialization: Surgical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 17 EXCHANGE ST W
    SUITE 222
    SAINT PAUL, MN
    ZIP 55102
  • Phone: (651) 224-7854

Map and Directions

Get Directions

NPI Details

Ethan Conroy, PAC is a surgical physician assistant in Saint Paul, MN. Ethan Conroy, PAC NPI is 1023089547. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

17 EXCHANGE ST W
SUITE 222
SAINT PAUL, MN
ZIP 55102-045
Phone: (651) 224-7854

The NPI 1023089547 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 2/1/2006 and was last updated on 10/30/2014.

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
1363AM0700XPhysician AssistantMedical9849MINNESOTANo
2363AS0400XPhysician AssistantSurgical9849MINNESOTAYes

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
1Q17303MEDICARE UPINMINNESOTA
2970001924MEDICARE ID-TYPE UNSPECIFIEDMINNESOTA
3923192700MEDICAIDMINNESOTA

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: 11/21/2025

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