| Shriners Children's | |
|
215 Radio Dr Ste 100 Woodbury MN 55125-5817 | |
| (612) 596-6100 | |
| Not Available |
| Full Name | Shriners Children's |
|---|---|
| Speciality | Clinic/Center |
| Location | 215 Radio Dr Ste 100, Woodbury, Minnesota |
| Authorized Official Name and Position | Jerry G. Gantt (PRESIDENT) |
| Authorized Official Contact | 8132810300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shriners Children's Po Box 8500 Lockbox 7642 Philadelphia PA 19178-1435 Ph: (813) 281-0300 | Shriners Children's 215 Radio Dr Ste 100 Woodbury MN 55125-5817 Ph: (612) 596-6100 |
| NPI Number | 1285250977 |
|---|---|
| Provider Enumeration Date | 06/18/2020 |
| Last Update Date | 10/28/2021 |
| Medicare PECOS PAC ID | 9133031933 |
|---|---|
| Medicare Enrollment ID | O20140606000217 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285250977 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QR0400X | Clinic/center - Rehabilitation | (* (Not Available)) | Primary |
| Provider Name | Lael M Luedtke |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1285676668 PECOS PAC ID: 7214832278 Enrollment ID: I20031203000331 |
| Provider Name | David Wayne Polly |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1669483046 PECOS PAC ID: 2961309729 Enrollment ID: I20031218000571 |
| Provider Name | Sonia Lucille Wright |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104804343 PECOS PAC ID: 1557323136 Enrollment ID: I20041027000760 |
| Provider Name | Peter Karachunski |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1720176308 PECOS PAC ID: 7719911825 Enrollment ID: I20050919000678 |
| Provider Name | Annalise N Larson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1134105117 PECOS PAC ID: 0143254466 Enrollment ID: I20050926000330 |
| Provider Name | Ann E Van Heest |
|---|---|
| Provider Type | Practitioner - Hand Surgery |
| Provider Identifiers | NPI Number: 1194833376 PECOS PAC ID: 7113942335 Enrollment ID: I20051006000879 |
| Provider Name | Jennifer H Kyllo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1679565774 PECOS PAC ID: 8224049945 Enrollment ID: I20060509000923 |
| Provider Name | Patrick C Graupman |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1639245822 PECOS PAC ID: 1759359243 Enrollment ID: I20070125000219 |
| Provider Name | Anne Weisensee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992784755 PECOS PAC ID: 8729992433 Enrollment ID: I20080620000583 |
| Provider Name | David Drake |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528046612 PECOS PAC ID: 7517871288 Enrollment ID: I20080620000617 |
| Provider Name | Robin C Crandall |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1033131438 PECOS PAC ID: 1759327273 Enrollment ID: I20100116000254 |
| Provider Name | Thomas G Mason |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1104805522 PECOS PAC ID: 0648312280 Enrollment ID: I20100120000888 |
| Provider Name | Steven L Moran |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1649259557 PECOS PAC ID: 5193869352 Enrollment ID: I20100225000714 |
| Provider Name | Debbie K Song |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1881717973 PECOS PAC ID: 2264604842 Enrollment ID: I20111003000498 |
| Provider Name | Elizabeth W Bizier |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1497782718 PECOS PAC ID: 4385664416 Enrollment ID: I20111031000772 |
| Provider Name | Cary H Mielke |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1568549574 PECOS PAC ID: 4183848492 Enrollment ID: I20140606000499 |
| Provider Name | Rebecca L Rouse |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1629477310 PECOS PAC ID: 3274850714 Enrollment ID: I20150323001260 |
| Provider Name | Waleed Gibreel |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1114367042 PECOS PAC ID: 5193967453 Enrollment ID: I20150803001878 |
| Provider Name | Christopher S Vara |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1659566479 PECOS PAC ID: 5597794149 Enrollment ID: I20150908001494 |
| Provider Name | Michael Priola |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1134321789 PECOS PAC ID: 3476725813 Enrollment ID: I20161216001170 |
| Provider Name | Matthew Basiaga |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689800260 PECOS PAC ID: 5395900898 Enrollment ID: I20190521002755 |
| Provider Name | Wendy A Tomhave |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1780914705 PECOS PAC ID: 2062745250 Enrollment ID: I20190603001051 |
| Provider Name | Sarah J Scudder |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1295210888 PECOS PAC ID: 1951634542 Enrollment ID: I20190613002058 |
| Provider Name | Kaile C Damm |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1801499439 PECOS PAC ID: 0648685081 Enrollment ID: I20210218000065 |
| Provider Name | Lindsay P Stephenson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1487919643 PECOS PAC ID: 8022239987 Enrollment ID: I20220711003717 |
| Provider Name | Melissa L Forrest |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1497419873 PECOS PAC ID: 7810363157 Enrollment ID: I20221012000564 |
| Provider Name | Rebecca A Kelly |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1477199628 PECOS PAC ID: 5193193415 Enrollment ID: I20221117001783 |
| Provider Name | Gregory D Kalv |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1033347638 PECOS PAC ID: 6406095066 Enrollment ID: I20221221001016 |
| Provider Name | Mary L Beck |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1659384337 PECOS PAC ID: 9335448687 Enrollment ID: I20230802002626 |
| Provider Name | Preetha Keya Sinha |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1003252198 PECOS PAC ID: 7416190152 Enrollment ID: I20240207003595 |
Healthpartners Specialty Center Woodbury Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 233 Radio Dr, Woodbury, MN 55125 Phone: 651-254-7400 | |
Ilko Family Medicine Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1687 Woodlane Dr, Suite 102, Woodbury, MN 55125 Phone: 651-209-6685 Fax: 651-209-1680 | |
Woodbury Obstetrics & Gynecology Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8360 City Centre Dr, Suite 120, Woodbury, MN 55125 Phone: 651-739-2182 Fax: 651-739-2045 | |
Future Health Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8362 Tamarack Vlg Ste 119-401, Woodbury, MN 55125 Phone: 952-541-7157 | |
Central Pediatrics, P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9680 Tamarack Rd Ste 100, Woodbury, MN 55125 Phone: 651-738-0470 Fax: 651-731-5031 | |
Minnhealth - Woodbury Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8325 City Centre Dr, Woodbury, MN 55125 Phone: 651-731-0859 Fax: 651-731-0976 |