LIFE CLINIC MEDICAL, PA NPI 1942546692

Internal Medicine in St Louis Park, MN

NPI 1942546692 Organization Internal Medicine CLIA Number 24D2058864 CLIA Certificate of Waiver

About LIFE CLINIC MEDICAL, PA

Life Clinic Medical, Pa is an internal medicine provider established in St Louis Park, Minnesota specializing in internal medicine. The NPI number of Life Clinic Medical, Pa is 1942546692 and was assigned on December 2012. The practitioner's primary taxonomy code is 207R00000X with license number 1865 (MN). The provider is registered as an organization and their NPI record was last updated 8 years ago. Life Clinic Medical, Pa operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The authorized official of this NPI record is Dr. Kambiz Farbakhsh M.d. (Owner/ Founder)

An internist like Life Clinic Medical, Pa is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

The CLIA number of Life Clinic Medical, Pa is 24D2058864 registered as a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Life Clinic Medical, Pa to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1942546692

Provider NameLIFE CLINIC MEDICAL, PA
Provider Location Address5525 CEDAR LAKE RD S ST LOUIS PARK, MN 55416
Provider Mailing Address2902 CORPORATE PL CORPORATE CHANHASSEN, MN 55317
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date12-28-2012
Last Update Date05-17-2013


Primary Taxonomy

Taxonomy Code207R00000X
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
License No.1865
License StateMN
Taxonomy DescriptionA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Business Address

LIFE CLINIC MEDICAL, PA
5525 CEDAR LAKE RD S
ST LOUIS PARK, MN
ZIP 55416
Phone: (866) 240-8437
Fax: (866) 240-9836

Get Directions


Mailing Address

LIFE CLINIC MEDICAL, PA
2902 CORPORATE PL
CORPORATE
CHANHASSEN, MN
ZIP 55317
Phone: (866) 240-8437



Authorized Official

Authorized Official NameDR. KAMBIZ FARBAKHSH M.D.
Authorized Official TitleOWNER/ FOUNDER
Authorized Official Phone(866) 240-8437

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1942546692 is:

CLIA Number24D2058864
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate of Waiver

Group Taxonomy


193200000X MULTI-SPECIALTY GROUP - This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

Other Providers at the same location


The following 12 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1144413832DR. CHRISTOPHER CHARLES LAUER D.C.
Individual
Chiropractor5525 CEDAR LAKE RD S
ST LOUIS PARK, MN 55416
(952) 541-7171
1356751523LIFECLINIC REHABILITATION AND CHIROPRACTIC
Organization
Chiropractor5525 CEDAR LAKE RD S
ST LOUIS PARK, MN 55416
(952) 546-5474
1790195774DR. NICHOLAS NOVAKOSKI D.C.
Individual
Student in an Organized Health Care Education/Training Program5525 CEDAR LAKE RD S
ST LOUIS PARK, MN 55416
(952) 546-5474
1861471666 JENNIFER L MEARS RN, CNP
Individual
Nurse Practitioner (Family)5525 CEDAR LAKE RD S
ST LOUIS PARK, MN 55416
(952) 541-7157
1861673055 HANNAH TANNER FNP
Individual
Nurse Practitioner5525 CEDAR LAKE RD S
ST LOUIS PARK, MN 55416
(952) 541-7157
1922416064LIFECLINIC PA
Organization
Chiropractor (Rehabilitation)5525 CEDAR LAKE RD S
ST LOUIS PARK, MN 55416
(952) 229-7901
1023296167LIFE CLINIC, P.A.
Organization
Chiropractor (Rehabilitation)5525 CEDAR LAKE RD S
ST LOUIS PARK, MN 55416
(651) 690-0866
1669851986 THOMAS KLUSMANN
Individual
Physical Therapy Assistant5525 CEDAR LAKE RD S
ST LOUIS PARK, MN 55416
(952) 541-7171
1942664024 EMILY SAMBORN NP
Individual
Nurse Practitioner (Gerontology)5525 CEDAR LAKE RD S
ST LOUIS PARK, MN 55416
(952) 541-7157
1659666931 JOSIAH LEE THUNSHELLE PT
Individual
Physical Therapist5525 CEDAR LAKE RD S
ST LOUIS PARK, MN 55416
(701) 391-4084
1629683180 NATHANIEL ARTHUR MURRAY PT, DPT, MS
Individual
Physical Therapist5525 CEDAR LAKE RD S
ST LOUIS PARK, MN 55416
(952) 541-7171
1144790866MRS. ASHLEY MARIE WILSON PA-C
Individual
Physician Assistant5525 CEDAR LAKE RD S
ST LOUIS PARK, MN 55416
(952) 541-7157

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.