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2601 Centennial Dr Suite 100 Saint Paul MN 55109-3041 | |
(651) 777-7414 | |
(651) 748-5839 |
Full Name | |
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Speciality | Family Medicine |
Location | 2601 Centennial Dr, Saint Paul, Minnesota |
Authorized Official Name and Position | Paul Berrisford (CEO) |
Authorized Official Contact | 6517721572 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2025 Sloan Pl Suite 35 Saint Paul MN 55117-2007 Ph: (651) 772-2077 | 2601 Centennial Dr Suite 100 Saint Paul MN 55109-3041 Ph: (651) 777-7414 |
NPI Number | 1013135508 |
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Provider Enumeration Date | 04/23/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1013135508 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 1417 (Minnesota) | 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 |