Provider Demographics
NPI:1770081176
Name:INSIGHT CARE P.A.
Entity type:Organization
Organization Name:INSIGHT CARE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOONE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHOUTHAVANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-250-0263
Mailing Address - Street 1:11660 THEATRE DR N STE 270
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-4527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 CIVIC HEIGHTS DR STE 109
Practice Address - Street 2:
Practice Address - City:CIRCLE PINES
Practice Address - State:MN
Practice Address - Zip Code:55014-4709
Practice Address - Country:US
Practice Address - Phone:612-321-8085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR190679-2363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty