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2001 Van Dyke St Maplewood MN 55109-3711 | |
(651) 290-6818 | |
(651) 290-6818 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2001 Van Dyke St, Maplewood, Minnesota |
Authorized Official Name and Position | Mavis Carol Brehm (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 6516027536 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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153 Cesar Chavez St Saint Paul MN 55107-2226 Ph: (651) 222-1816 | 2001 Van Dyke St Maplewood MN 55109-3711 Ph: (651) 290-6818 |
NPI Number | 1730203944 |
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Provider Enumeration Date | 03/16/2007 |
Last Update Date | 06/18/2008 |
Medicare PECOS PAC ID | 2062306434 |
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Medicare Enrollment ID | O20061117000440 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730203944 | NPI | - | NPPES |
310055100 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Minnesota) | Primary |
Polaris Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2053 Woodlynn Ave, Maplewood, MN 55109 Phone: 651-431-0047 | |
My Medical Clinic Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1560 Beam Ave, Maplewood, MN 55109 Phone: 651-484-6923 |