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233 Grand Ave Saint Paul MN 55102-2331 | |
(651) 241-5200 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 233 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 | 233 Grand Ave Saint Paul MN 55102-2331 Ph: (651) 241-5200 |
NPI Number | 1346842051 |
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Provider Enumeration Date | 11/09/2020 |
Last Update Date | 01/22/2025 |
Identifier | Type | State | Issuer |
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1346842051 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (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 |