Organization · NPI-2

Advanced Spine And Pain Clinics Of Minnesota LLC

· Minneapolis, MN

NPI number1891055851

StatusActive

Last updated in NPPESFeb 7, 2022

Details

NPI: 1891055851
Entity type: Organization (NPI-2)
Legal business name: Advanced Spine And Pain Clinics Of Minnesota LLC
Organization subpart: No
Enumeration date: May 24, 2012
Certification date: Apr 29, 2021
Last updated: Feb 7, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
208VP0000X		–	–	Yes
207LP2900X	Anesthesiology, Pain Medicine	–	–
208100000X	Physical Medicine & Rehabilitation	–	–
2081P0004X	Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine	–	–
2081P2900X	Physical Medicine & Rehabilitation, Pain Medicine	–	–
208VP0014X	Pain Medicine, Interventional Pain Medicine	–	–

Practice location

2801 Wayzata Blvd
Minneapolis, MN 55405-2125

Phone 612-207-7463 · Fax 612-315-4473

Mailing address

2801 Wayzata Blvd
Minneapolis, MN 55405-2125

Phone 612-207-7463 · Fax 952-831-0276

Authorized official

Matthew Gerald Thorson
President/Owner
6122077463

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