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4000 Central Ave Ne Columbia Heights MN 55421-2968 | |
| (763) 572-5710 | |
| (763) 782-8100 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 4000 Central Ave Ne, Columbia Heights, Minnesota |
| Authorized Official Name and Position | Joen V Condon (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7635865839 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6401 University Ave Ne Fridley MN 55432-4341 Ph: (763) 572-5710 | 4000 Central Ave Ne Columbia Heights MN 55421-2968 Ph: (763) 572-5710 |
| NPI Number | 1609971159 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 11/13/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609971159 | NPI | - | NPPES |
| CT1003 | Other | MN | MEDICARE RAILROAD |
| 1247 | Other | MN | HEALTHPARTNERS |
| 104020 | Other | MN | UCARE CLINIC NUMBER |
| 02071BR | Other | MN | BCBS OF MN |
| 98-01408 | Other | MN | MEDICA CLINIC NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (Minnesota) | Primary |
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