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740 East 17th Street Minneapolis MN 55404-1601 | |
(612) 348-5553 | |
(612) 677-6299 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 740 East 17th Street, Minneapolis, Minnesota |
Authorized Official Name and Position | Stephanie Abel (AREA MANAGER) |
Authorized Official Contact | 6123488824 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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525 Portland Ave # Mc963 Minneapolis MN 55415-1533 Ph: (612) 348-5553 | 740 East 17th Street Minneapolis MN 55404-1601 Ph: (612) 348-5553 |
NPI Number | 1528539624 |
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Provider Enumeration Date | 12/16/2018 |
Last Update Date | 12/19/2018 |
Identifier | Type | State | Issuer |
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1528539624 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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