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1400 Queen Ave N Minneapolis MN 55411-2926 | |
| (651) 425-1614 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 1400 Queen Ave N, Minneapolis, Minnesota |
| Authorized Official Name and Position | Xeng Y Pha (OWNER) |
| Authorized Official Contact | 6514251614 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
9216 White Oaks Trl Champlin MN 55316-2675 Ph: () - | 1400 Queen Ave N Minneapolis MN 55411-2926 Ph: (651) 425-1614 |
| NPI Number | 1477330330 |
|---|---|
| Provider Enumeration Date | 09/13/2023 |
| Last Update Date | 07/30/2024 |
| Certification Date | 07/30/2024 |
| Medicare PECOS PAC ID | 6103359898 |
|---|---|
| Medicare Enrollment ID | O20241104000177 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477330330 | NPI | - | NPPES |
| Provider Name | Xeng Ying Pha |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518565126 PECOS PAC ID: 7911430608 Enrollment ID: I20241104000193 |
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