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5130 Fairview Blvd Suite 101 Wyoming MN 55092 | |
(651) 982-7800 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 5130 Fairview Blvd, Wyoming, Minnesota |
Authorized Official Name and Position | Robert Andrew Mccoy (VP REVENUE MANAGEMENT) |
Authorized Official Contact | 6126726594 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 9372 Minneapolis MN 55440-9372 Ph: () - | 5130 Fairview Blvd Suite 101 Wyoming MN 55092 Ph: (651) 982-7800 |
NPI Number | 1275875031 |
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Provider Enumeration Date | 03/20/2013 |
Last Update Date | 10/19/2020 |
Identifier | Type | State | Issuer |
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1275875031 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |