Provider Demographics
NPI:1972520773
Name:CENTRAL MINNESOTA NEUROSCIENCES LTD
Entity type:Organization
Organization Name:CENTRAL MINNESOTA NEUROSCIENCES LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-251-2700
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-0340
Mailing Address - Country:US
Mailing Address - Phone:320-258-8456
Mailing Address - Fax:320-259-5896
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-255-5622
Practice Address - Fax:320-259-5896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty