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410 Church St Se Minneapolis MN 55455-0340 | |
| (612) 625-8400 | |
| (612) 625-1434 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Student Health |
| Location | 410 Church St Se, Minneapolis, Minnesota |
| Authorized Official Name and Position | Carl B. Anderson (DIRECTOR AND CHIEF HEALTH OFFICER) |
| Authorized Official Contact | 6126255992 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
410 Church Street Se Minneapolis MN 55455-0346 Ph: (612) 625-8400 | 410 Church St Se Minneapolis MN 55455-0340 Ph: (612) 625-8400 |
| NPI Number | 1013137355 |
|---|---|
| Provider Enumeration Date | 04/27/2007 |
| Last Update Date | 10/05/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013137355 | NPI | - | NPPES |
| 322012500 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Primary |
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