Native American Community Clinic | |
1213 E Franklin Ave Minneapolis MN 55404-2923 | |
(612) 872-8086 | |
(612) 872-8547 |
Full Name | Native American Community Clinic |
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Speciality | Community/Behavioral Health |
Location | 1213 E Franklin Ave, Minneapolis, Minnesota |
Authorized Official Name and Position | Lydia Beth Caros (CEO) |
Authorized Official Contact | 6128728086 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Native American Community Clinic 1213 E Franklin Ave Minneapolis MN 55404-2923 Ph: (612) 872-8086 | Native American Community Clinic 1213 E Franklin Ave Minneapolis MN 55404-2923 Ph: (612) 872-8086 |
NPI Number | 1730366600 |
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Provider Enumeration Date | 01/23/2008 |
Last Update Date | 09/15/2015 |
Medicare PECOS PAC ID | 8224921978 |
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Medicare Enrollment ID | O20200706001319 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730366600 | NPI | - | NPPES |
596112000 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Provider Name | Timothy Jandro |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1255976437 PECOS PAC ID: 9436582459 Enrollment ID: I20191205002064 |
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