| Southdale Pediatric Associates, Ltd | |
|
3955 Parklawn Ave Ste 120 Edina MN 55435-5655 | |
| (952) 831-1944 | |
| (952) 278-6947 |
| Full Name | Southdale Pediatric Associates, Ltd |
|---|---|
| Speciality | Clinic/Center |
| Location | 3955 Parklawn Ave, Edina, Minnesota |
| Authorized Official Name and Position | Vicki Oster (PRESIDENT) |
| Authorized Official Contact | 9528311944 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southdale Pediatric Associates, Ltd 3955 Parklawn Ave Ste 120 Edina MN 55435-5655 Ph: (952) 831-1944 | Southdale Pediatric Associates, Ltd 3955 Parklawn Ave Ste 120 Edina MN 55435-5655 Ph: (952) 831-1944 |
| NPI Number | 1245305895 |
|---|---|
| Provider Enumeration Date | 11/21/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4981597077 |
|---|---|
| Medicare Enrollment ID | O20040203000879 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245305895 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 196 (Minnesota) | Primary |
| Provider Name | Timothy J Anderson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1245243138 PECOS PAC ID: 1951290329 Enrollment ID: I20040312001218 |
| Provider Name | Mee Lee C Nelson |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1972510220 PECOS PAC ID: 3173526233 Enrollment ID: I20060810000574 |
| Provider Name | Melissa A Hersey |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1750551727 PECOS PAC ID: 4284780727 Enrollment ID: I20090924000129 |
| Provider Name | David P Miller |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1851404644 PECOS PAC ID: 1658410311 Enrollment ID: I20091209000509 |
| Provider Name | Aaron Pinion |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1255642294 PECOS PAC ID: 3476868431 Enrollment ID: I20150819009016 |
| Provider Name | Britta K Sundquist |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1548550916 PECOS PAC ID: 1759653074 Enrollment ID: I20181120000743 |
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