Provider Demographics
NPI:1447529235
Name:CHILDREN'S CLINIC NETWORK
Entity type:Organization
Organization Name:CHILDREN'S CLINIC NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VP AND CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA LU
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-813-6129
Mailing Address - Street 1:5901 LINCOLN DRIVE, CBC-2-REV/PE
Mailing Address - Street 2:CHILDREN'S CLINIC NETWORK
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1611
Mailing Address - Country:US
Mailing Address - Phone:952-992-5691
Mailing Address - Fax:952-992-6917
Practice Address - Street 1:14701 VICTOR HUGO BLVD N
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-4561
Practice Address - Country:US
Practice Address - Phone:651-426-1141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care