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SOUTHDALE MEDICAL PARTNERS CORPORATION
NPI 1043898778
Nurse Practitioner - Primary Care in Oakdale, MN

Active since April 01, 2021
902 INWOOD AVE N STE 902, OAKDALE, MN 55128(952) 999-4049 Get Directions Write a Review

NPPES record last updated: May 3, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 3, 2023, Dec 8, 2022, Apr 1, 2021 (3 updates tracked since 2021).

About Southdale Medical Partners Corporation NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHDALE MEDICAL PARTNERS CORPORATION (NPI 1043898778) is a healthcare organization registered as a primary care in Oakdale, Minnesota and active in the NPI registry since April 2021. The organization maintains a secondary practice location in Edina and lists Mitchell Paul Brandt, Administrator, as its authorized official.

NPPES Registry Identity

NPI1043898778
Entity TypeOrganization
Primary Taxonomy363LP2300X
Legal Business NameSOUTHDALE MEDICAL PARTNERS CORPORATION
Location Address902 INWOOD AVE N STE 902Oakdale, MN 55128-6625
Mailing Address902 Inwood Ave NSaint Paul, MN 55128-6625 · (651) 815-6880
Phone(952) 999-4049
Organization SubpartNo
Authorized OfficialMitchell Paul BrandtAdministrator · (612) 961-4322
Enumeration DateApril 1, 2021
Last NPPES UpdateMay 3, 20233 updates tracked since enumeration
NPPES CertifiedJanuary 12, 2023
✔ NPI 1043898778 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
Also ListedFamily MedicineTaxonomy 207Q00000X
902 INWOOD AVE N STE 902, Oakdale, MN 55128
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Secondary Practice Location 1

Location 16565 France Ave S Ste 350Edina, MN 55435-2159 · Phone (952) 999-4049 · Fax (952) 999-4080

Group Practice 2

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D2265307

Southdale Medical Partners · Edina, MN
Expired · Jul 25, 2026
CLIA Number24D2265307
Laboratory TypePhysician Office
Certificate Effective DateJuly 26, 2024
Certificate Expiration DateJuly 25, 2026
Laboratory DirectorMerlin E. Brown
Laboratory Phone(952) 999-4049
Laboratory LocationSouthdale Medical Partners6565 France Ave S Ste 350, Edina, MN 55435
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southdale Medical Partners Corporation's NPI number?

The NPI number for Southdale Medical Partners Corporation is 1043898778. It was assigned to this organization in the NPPES registry on April 1, 2021.

Where is Southdale Medical Partners Corporation located?

Southdale Medical Partners Corporation is located at 902 Inwood Ave N Ste 902, Oakdale, MN 55128. The listed phone number is (952) 999-4049.

What is Southdale Medical Partners Corporation's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

When was this NPI record last updated?

The NPPES record for Southdale Medical Partners Corporation was last updated on May 3, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.