PEDIATRIC AND YOUNG ADULT MEDICINE PA NPI 1205078300

NPI Information

  • NPI: 1205078300
  • Provider Name: PEDIATRIC AND YOUNG ADULT MEDICINE, PA
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • CLIA Number: 24D0399838
  • Address: 3470 WASHINGTON DR
    SUITE 201
    EAGAN, MN
    ZIP 55122
  • Phone: (651) 256-6706

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NPI Details

PEDIATRIC AND YOUNG ADULT MEDICINE, PA is a primary care clinic center in Eagan, MN. PEDIATRIC AND YOUNG ADULT MEDICINE, PA NPI is 1205078300. The provider is registered as an organization entity type.

The provider's business location address is:

3470 WASHINGTON DR
SUITE 201
EAGAN, MN
ZIP 55122-355
Phone: (651) 256-6706
Fax: (651) 256-6766

The provider's authorized official is Terri M Joseph .
The authorized official title is Office Manager and has the following contact phone number (651) 256-6706.

The CLIA number assigned to this NPI record is 24D0399838 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 4/3/2009 and was last updated on 12/7/2016.

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
1261QP2300XClinic/CenterPrimary Care154MINNESOTAYes

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
11477870921MEDICAIDMINNESOTA
21245210210MEDICAIDMINNESOTA
31104806165MEDICAIDMINNESOTA
41245210095MEDICAIDMINNESOTA
51497735419MEDICAIDMINNESOTA
61861558835MEDICAIDMINNESOTA
71912987900MEDICAIDMINNESOTA
81881057065MEDICAIDMINNESOTA
91083694046MEDICAIDMINNESOTA
101386991339MEDICAIDMINNESOTA

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: 3/30/2025

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