| Healtheast Grand Avenue Clinic | |
|
870 Grand Ave Saint Paul MN 55105-3291 | |
| (651) 326-5650 | |
| (651) 326-5671 |
| Full Name | Healtheast Grand Avenue Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 870 Grand Ave, Saint Paul, Minnesota |
| Authorized Official Name and Position | Doug Davenport (CFO) |
| Authorized Official Contact | 6512322250 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Healtheast Grand Avenue Clinic 870 Grand Ave Saint Paul MN 55105-3291 Ph: (651) 326-5650 | Healtheast Grand Avenue Clinic 870 Grand Ave Saint Paul MN 55105-3291 Ph: (651) 326-5650 |
| NPI Number | 1730128398 |
|---|---|
| Provider Enumeration Date | 06/06/2006 |
| Last Update Date | 05/21/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730128398 | NPI | - | NPPES |
| 0841630019 | Other | MN | MEDICARE PTAN |
| 500719400 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
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