| Washington High School Clinic | |
|
495 Rice Street St Paul MN 55117-3864 | |
| (651) 487-8531 | |
| (651) 487-8532 |
| Full Name | Washington High School Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 495 Rice Street, St Paul, Minnesota |
| Authorized Official Name and Position | Reuben Moore (CEO) |
| Authorized Official Contact | 6516027500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Washington High School Clinic 153 Cesar Chavez St Saint Paul MN 55107-2226 Ph: (651) 602-7500 | Washington High School Clinic 495 Rice Street St Paul MN 55117-3864 Ph: (651) 487-8531 |
| NPI Number | 1457475543 |
|---|---|
| Provider Enumeration Date | 03/16/2007 |
| Last Update Date | 05/15/2024 |
| Medicare PECOS PAC ID | 2062306434 |
|---|---|
| Medicare Enrollment ID | O20061117000453 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457475543 | NPI | - | NPPES |
| 252459700 | Medicaid | MN | |
| 103124 | Other | MN | UCARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Minnesota) | Primary |
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