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1025 Selby Ave Suite 101 Saint Paul MN 55104-6533 | |
(651) 228-9000 | |
(651) 224-2806 |
Full Name | |
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Speciality | Clinic/center |
Location | 1025 Selby Ave, Saint Paul, Minnesota |
Authorized Official Name and Position | Trisha Lee Augustine (MANAGING MEMBER) |
Authorized Official Contact | 9522202857 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1025 Selby Ave Suite 101 Saint Paul MN 55104-6533 Ph: (651) 228-9000 | 1025 Selby Ave Suite 101 Saint Paul MN 55104-6533 Ph: (651) 228-9000 |
NPI Number | 1912304627 |
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Provider Enumeration Date | 11/24/2014 |
Last Update Date | 04/27/2015 |
Identifier | Type | State | Issuer |
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1912304627 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 5983 (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 |