| Sbtv Llc | |
|
6121 Excelsior Blvd Ste 101a St Louis Park MN 55416-2752 | |
| (612) 440-8742 | |
| (716) 531-9060 |
| Full Name | Sbtv Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6121 Excelsior Blvd Ste 101a, St Louis Park, Minnesota |
| Authorized Official Name and Position | Natalie M Marr (OWNER) |
| Authorized Official Contact | 6124408742 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sbtv Llc Po Box 490171 Minneapolis MN 55449-0171 Ph: (612) 440-8742 | Sbtv Llc 6121 Excelsior Blvd Ste 101a St Louis Park MN 55416-2752 Ph: (612) 440-8742 |
| NPI Number | 1992265615 |
|---|---|
| Provider Enumeration Date | 03/20/2019 |
| Last Update Date | 06/11/2019 |
| Medicare PECOS PAC ID | 5597006882 |
|---|---|
| Medicare Enrollment ID | O20190415002270 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992265615 | NPI | - | NPPES |
| 4960 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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