Provider Demographics
NPI:1366751521
Name:UNITED HOSPITAL
Entity type:Organization
Organization Name:UNITED HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB SERVICES LEADER
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:651-241-8290
Mailing Address - Street 1:333 SMITH AVE N
Mailing Address - Street 2:MAIL ROUTE 660104
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2344
Mailing Address - Country:US
Mailing Address - Phone:651-241-8290
Mailing Address - Fax:651-241-7177
Practice Address - Street 1:333 SMITH AVE N
Practice Address - Street 2:MAIL ROUTE 660104
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2344
Practice Address - Country:US
Practice Address - Phone:651-241-8290
Practice Address - Fax:651-241-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8594282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital