Provider Demographics
NPI:1144368531
Name:UNIVERSITY OF MINNESOTA PHYSICIANS
Entity type:Organization
Organization Name:UNIVERSITY OF MINNESOTA PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-884-0600
Mailing Address - Street 1:PO BOX 860217
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0217
Mailing Address - Country:US
Mailing Address - Phone:763-782-6400
Mailing Address - Fax:763-782-9558
Practice Address - Street 1:5775 WAYZATA BLVD STE 255
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1275
Practice Address - Country:US
Practice Address - Phone:122-738-7106
Practice Address - Fax:612-273-8727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN701372800Medicaid
MN701372800Medicaid