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167 Grand Ave Saint Paul MN 55102-2318 | |
(651) 241-4477 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Community Health |
Location | 167 Grand Ave, Saint Paul, Minnesota |
Authorized Official Name and Position | Dominica Tallarico (COO) |
Authorized Official Contact | 6122222222 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 43 Mail Route 10585 Minneapolis MN 55440-0043 Ph: (612) 262-1166 | 167 Grand Ave Saint Paul MN 55102-2318 Ph: (651) 241-4477 |
NPI Number | 1346771896 |
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Provider Enumeration Date | 03/27/2017 |
Last Update Date | 01/22/2025 |
Identifier | Type | State | Issuer |
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1346771896 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
Premiere Mental Health Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 360 Sherman St Ste 290, Saint Paul, MN 55102 Phone: 763-913-8125 |