NORTHEAST PEDIATRIC CLINIC P.A. (NPI# 1730162371) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730162371 |
| Entity Type | Organization |
| Organization Name | NORTHEAST PEDIATRIC CLINIC P.A. |
| Practice Address |
4520 Centerville Rd Vadnais Heights MN 55127-3602 |
| Practice Telephone | 6514261141 |
| Practice Fax Number | 6514261705 |
| Mailing Telephone | 6514261141 |
| Mailing Fax Number | 6514261705 |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. MARY ANN LEUKUMA (CEO) |
| Authorized Official Telephone | 6514261141 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Street Address |
4520 CENTERVILLE RD |
| City | VADNAIS HEIGHTS |
| State | MN |
| Zip Code | 55127-3602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316920853 | Kristin G Heuermann | Pediatrics | 4520 Centerville Rd, Vadnais Heights, MN 55127-3602 | 2005-11-29 |
| 1477869311 | Children's Health Care | Clinic/Center | 4520 Centerville Rd, Vadnais Heights, MN 55127-3602 | 2010-08-30 |
| 1023092434 | Catherine S. Bedford | Pediatrics | 4520 Centerville Rd, Vadnais Heights, MN 55127-3602 | 2005-11-30 |
| 1033192588 | Mary Ann Leukuma | Pediatrics | 4520 Centerville Rd, Vadnais Heights, MN 55127-3602 | 2005-11-29 |
| 1609859149 | Gail Marie Casemore | Pediatrics | 4520 Centerville Rd, Vadnais Heights, MN 55127-3602 | 2005-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013514058 | Taylor Nessa Draves | Behavior Technician | 1011 Meadowlamds Dr, White Bear Lake, MN 55127 | 2020-10-02 |
| 1578104196 | Patricia Lynn Bina | Technician | 3677 Centerville Rd, Vadnais Heights, MN 55127 | 2019-10-04 |
| 1023538469 | Dignicare Senior Management of Vadnais | Assisted Living Facility | 580 Liberty Way, Vadnais Heights, MN 55127 | 2017-06-27 |
| 1548610207 | Golden Elderly Care Suites LLC | Assisted Living Facility | 4624 Stoddart Circle, White Bear Lake, MN 55127 | 2016-06-14 |
| 1811018203 | Adam F Curtis | Dentist | 925 East County Road E, Suite 185, Vadnais Heights, MN 55127 | 2007-04-03 |
| 1134215700 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 785 E County Road E, Vadnais Heights, NE 55127 | 2006-10-04 |
| 1861404790 | Gerald James Pease | Optometrist | 850 East Co Rd E, Walmart Vision Center, Vadnais Heights, MN 55127 | 2006-08-12 |
| 1235629395 | Suite Living Senior Management | Assisted Living Facility | 197 County Road B2 W, Roseville, MN 55127 | 2018-05-15 |
| 1760986624 | Diandra Shakira Williams | Physician Assistant | 3580 Arcade St, Vadnais Heights, MN 55127 | 2018-03-23 |
| 1811370729 | Sonya L Knudson | Psychologist | 4444 Centerville Rd Ste 235, White Bear Lake, MN 55127 | 2015-07-09 |
| Find all providers in zip 55127 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477869311 | Children's Health Care | Clinic/Center | 4520 Centerville Rd, Vadnais Heights, MN 55127-3602 | 2010-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003423252 | Good Clinic Mn Pllc | Clinic/Center | 315 1st Ave Ne, Minneapolis, MN 55413-5001 | 2020-09-30 |
| 1407496219 | Hope Health Initiative | Clinic/Center | 6818 Humboldt Ave N, Brooklyn Center, MN 55430-1536 | 2020-01-09 |
| 1902392525 | Odam Medical Group | Clinic/Center | 3405 3rd St N, Saint Cloud, MN 56303-4015 | 2018-07-06 |
| 1376041822 | Piic Clinical Services | Clinic/Center | 6500 Humboldt Ave N, Brooklyn Center, MN 55430-1800 | 2018-01-30 |
| 1760905475 | Patient Centered Care | Clinic/Center | 8240 Hampshire Ct N, Brooklyn Park, MN 55445 | 2017-07-25 |
| 1740703339 | Neopath | Clinic/Center | 119 30th Ave W Ste 119, Alexandria, MN 56308-3433 | 2017-07-25 |
| 1720500309 | Centracare Clinic | Clinic/Center | 2749 Sexton Drive, Mary Hall - Room 001, Collegeville, MN 56321 | 2017-07-14 |
| 1881116747 | Centracare Clinic | Clinic/Center | 402 Red River Ave N Ste 2, Cold Spring, MN 56320-1523 | 2017-07-12 |
| 1558898387 | Centracare Clinic | Clinic/Center | 161 Glen St., Ste 101, Foley, MN 56329 | 2017-05-11 |
| 1164958104 | Centracare Clinic | Clinic/Center | 113 Waite Ave S Ste 101, Waite Park, MN 56387-1348 | 2017-05-11 |
| Find all providers with the same taxonomy | ||||
| City | VADNAIS HEIGHTS |
| Zip Code | 55127 |
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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.