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640 Jackson St Saint Paul MN 55101-2502 | |
| (651) 254-3456 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 640 Jackson St, Saint Paul, Minnesota |
| Authorized Official Name and Position | John Clark (VP FINANCE) |
| Authorized Official Contact | 6512540900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Regions Hospital Po Box 772739 Detroit MI 48277-2739 Ph: () - | 640 Jackson St Saint Paul MN 55101-2502 Ph: (651) 254-3456 |
| NPI Number | 1174168652 |
|---|---|
| Provider Enumeration Date | 11/08/2019 |
| Last Update Date | 12/09/2024 |
| Certification Date | 12/09/2024 |
| Medicare PECOS PAC ID | 3173436755 |
|---|---|
| Medicare Enrollment ID | O20191205000309 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174168652 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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