| Anoka Health Center Llc | |
|
2021 E Hennepin Ave Ste 475 Minneapolis MN 55413-1870 | |
| (612) 259-7803 | |
| Not Available |
| Full Name | Anoka Health Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2021 E Hennepin Ave Ste 475, Minneapolis, Minnesota |
| Authorized Official Name and Position | Faisal Hamud (OWNER) |
| Authorized Official Contact | 6122597803 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Anoka Health Center Llc 2021 E Hennepin Ave Ste 475 Minneapolis MN 55413-1870 Ph: () - | Anoka Health Center Llc 2021 E Hennepin Ave Ste 475 Minneapolis MN 55413-1870 Ph: (612) 259-7803 |
| NPI Number | 1053816389 |
|---|---|
| Provider Enumeration Date | 03/28/2018 |
| Last Update Date | 12/16/2022 |
| Certification Date | 12/16/2022 |
| Medicare PECOS PAC ID | 7719307735 |
|---|---|
| Medicare Enrollment ID | O20201013002528 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053816389 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Soukthanome X Thammavong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164986246 PECOS PAC ID: 4688914047 Enrollment ID: I20190321000408 |
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