SOUTHDALE PEDIATRIC ASSOCIATES, LTD (NPI# 1245305895) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245305895 |
| Entity Type | Organization |
| Organization Name | SOUTHDALE PEDIATRIC ASSOCIATES, LTD |
| Practice Address |
3955 Parklawn Ave Ste 120 Edina MN 55435-5655 |
| Practice Telephone | 9528311944 |
| Practice Fax Number | 9522786947 |
| Mailing Telephone | 9528311944 |
| Mailing Fax Number | 9522786947 |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. VICKI OSTER (PRESIDENT) |
| Authorized Official Telephone | 9528311944 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
196 | MN | Ambulatory Health Care Facilities |
| Street Address |
3955 PARKLAWN AVE STE 120 |
| City | EDINA |
| State | MN |
| Zip Code | 55435-5655 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396748307 | Lifescan Minnesota LLC | Clinic/Center | 3955 Parklawn Ave, Ste 110, Edina, MN 55435-5657 | 2005-05-23 |
| 1033506357 | Lauren Bray | Student in an Organized Health Care Education/Training Program | 3955 Parklawn Ave, Edina, MN 55435-5655 | 2015-04-24 |
| 1073831269 | Shannon Nicole Bailey Nolan | Pediatrics | 3955 Parklawn Ave, Suite 200, Edina, MN 55435-5655 | 2010-05-12 |
| 1790002889 | Megan Landry Stalpes | Pediatrics | 3955 Parklawn Ave, Edina, MN 55435-5655 | 2010-04-28 |
| 1528291168 | Karen E Tamte | Pediatrics | 3955 Parklawn Ave, Suite 120, Edina, MN 55435-5655 | 2009-08-31 |
| 1134354608 | Elsa Victoria Fiebiger | Pediatrics | 3955 Parklawn Ave, Suite 200, Edina, MN 55435-5655 | 2009-05-27 |
| 1356576938 | Megan Colleen Iliev | Pediatrics | 3955 Parklawn Ave, Suite 200, Edina, MN 55435-5655 | 2009-05-26 |
| 1649443920 | Amy Lynne Wudel | Pediatrics | 3955 Parklawn Ave, Suite 200, Edina, MN 55435 | 2008-04-08 |
| 1992975494 | Krista Rose Hagen | Pediatrics | 3955 Parklawn Ave, Suite 120, Edina, MN 55435-5655 | 2008-03-11 |
| 1891893996 | Sonja W Hinrichs | Pediatrics | 3955 Parklawn Ave, Ste 120, Edina, MN 55435-5655 | 2006-09-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104433416 | Evy Christine Claussen | Social Worker | 6363 France Ave. S., Edina, MN 55435 | 2020-09-30 |
| 1508496621 | Samantha Jean Mcgough Lamere | Physician Assistant | 4300 Marketpointe Drive, Suite 100, Bloomington, MN 55435 | 2020-01-16 |
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1730651639 | Taylor Lee Kehoe | Physician Assistant | 7400 France Ave., Suite #100, Edina, MN 55435 | 2018-12-18 |
| 1538666326 | Amanda Deangelo | Physical Therapist | 6401 Southdale Hospital, Ll3g, Edina, MN 55435 | 2018-04-09 |
| 1982107876 | Julia Seliber | Dental Hygienist | 7600 France Ave.s. Suite 1100, Edina, MN 55435 | 2018-03-16 |
| 1154840064 | Southhealth Asc, LLC | Clinic/Center | 4100 Minnesota Drive, Edina, MN 55435 | 2017-09-12 |
| 1730605528 | Edina Medical Supplies | Durable Medical Equipment & Medical Supplies | 7455 France Ave., #614 S, Edina, MN 55435 | 2017-08-14 |
| 1033565510 | Minnesota Disc Replacement and Spine Restoration Center | Clinic/Center | 4444 76 St, #700, Edina, MN 55435 | 2016-05-13 |
| 1306206321 | Barb Ryan | Mechanotherapist | 7550 France Avenue S, #220, Edina, MN 55435 | 2016-03-03 |
| Find all providers in zip 55435 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376756 | Premise Health of Minnesota Medical P C | Clinic/Center | 5901 Lincoln Dr, Edina, MN 55436-1611 | 2020-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245855162 | The Duluth Clinic Ltd | Clinic/Center | 1600 Miller Trunk Hwy Ste 1300, Duluth, MN 55811-5640 | 2020-06-16 |
| 1184250060 | Premise Health of Minnesota Medical P C | Clinic/Center | 1906 8th St Nw, Austin, MN 55912-2473 | 2020-03-23 |
| 1053952606 | Fairview Express Care | Clinic/Center | 2512 6th Street, Suite F105, Minneapolis, MN 55454-1401 | 2019-10-04 |
| 1730731464 | St Marys Regional Health Center | Clinic/Center | 1103 1st St E, Park Rapids, MN 56470 | 2019-07-12 |
| 1003478892 | The Duluth Clinic Ltd | Clinic/Center | 4289 Ugstad Rd, Hermantown, MN 55811-3615 | 2019-07-02 |
| 1073005856 | Arbor Integrative Behavioral Health | Clinic/Center | 1000 E 1st St Ste 105, Duluth, MN 55805-2297 | 2018-06-06 |
| 1689161077 | Chs Tennessee Medical P C | Clinic/Center | 701 Brooks Ave S, Thief River Falls, MN 56701-2757 | 2018-04-20 |
| 1427557867 | Gillette Children's Specialty Healthcare | Clinic/Center | 505 Paul Bunyan Dr Nw, Bemidji, MN 56601-2400 | 2018-02-11 |
| 1992224331 | Orthopedic & Sports Physical Therapy, Inc. | Clinic/Center | 322 N Tower Rd, Fergus Falls, MN 56537-1015 | 2017-09-18 |
| 1003339789 | Centracare Clinic | Clinic/Center | 2025 Stearns Way Ste 114, Saint Cloud, MN 56303 | 2017-07-25 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.