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1850 Beam Ave Maplewood MN 55109-1162 | |
(651) 241-9500 | |
(651) 770-8834 |
Full Name | |
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Speciality | Family Medicine |
Location | 1850 Beam Ave, Maplewood, Minnesota |
Authorized Official Name and Position | Dominica Tallarico (COO) |
Authorized Official Contact | 6122222222 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 43 Mail Route 10585 Minneapolis MN 55440-0043 Ph: (612) 262-1166 | 1850 Beam Ave Maplewood MN 55109-1162 Ph: (651) 241-9500 |
NPI Number | 1144526930 |
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Provider Enumeration Date | 01/27/2011 |
Last Update Date | 01/15/2025 |
Medicare PECOS PAC ID | 4587573613 |
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Medicare Enrollment ID | O20120227000308 |
Identifier | Type | State | Issuer |
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1144526930 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
Polaris Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2053 Woodlynn Ave, Maplewood, MN 55109 Phone: 651-431-0047 | |
My Medical Clinic Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1560 Beam Ave, Maplewood, MN 55109 Phone: 651-484-6923 |