| Gillette Childrens Specialty Healthcare | |
|
435 Phalen Blvd Saint Paul MN 55130-5302 | |
| (651) 636-9443 | |
| Not Available |
| Full Name | Gillette Childrens Specialty Healthcare |
|---|---|
| Speciality | Durable Medical Equipment & Medical Supplies |
| Location | 435 Phalen Blvd, Saint Paul, Minnesota |
| Authorized Official Name and Position | Patrick Nolan (CFO) |
| Authorized Official Contact | 6513123105 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gillette Childrens Specialty Healthcare 200 University Ave E Saint Paul MN 55101-2507 Ph: (651) 325-2177 | Gillette Childrens Specialty Healthcare 435 Phalen Blvd Saint Paul MN 55130-5302 Ph: (651) 636-9443 |
| NPI Number | 1760541700 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 12/13/2019 |
| Medicare PECOS PAC ID | 0547169211 |
|---|---|
| Medicare Enrollment ID | O20100930096637 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760541700 | NPI | - | NPPES |
| 11003700 | Medicaid | WI | |
| 51199 | Medicaid | ND | |
| 498935487 | Medicaid | MI | |
| 465410000 | Medicaid | MN | |
| 9163630 | Medicaid | SD | |
| 996047300 | Medicaid | MN | |
| 01267 | Medicaid | ND | |
| 41683100 | Medicaid | WI | |
| 310980000 | Medicaid | MN | |
| 0520726 | Medicaid | IA | |
| 0700813 | Medicaid | IA | |
| 1111HGI | Other | BLUE CROSS BLUE SHIELD | |
| 5521290 | Medicaid | SD |
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