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3152 Minnehaha Avenue Minneapolis MN 55406-1934 | |
| (612) 332-4973 | |
| (612) 238-3534 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 3152 Minnehaha Avenue, Minneapolis, Minnesota |
| Authorized Official Name and Position | Sahra Noor (CEO) |
| Authorized Official Contact | 6123324973 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
425 20th Avenue South Minneapolis MN 55454-4400 Ph: (612) 332-4973 | 3152 Minnehaha Avenue Minneapolis MN 55406-1934 Ph: (612) 332-4973 |
| NPI Number | 1871809152 |
|---|---|
| Provider Enumeration Date | 08/25/2010 |
| Last Update Date | 06/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871809152 | NPI | - | NPPES |
| 877361100 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Minnesota) | Primary |
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