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2945 Hazelwood St Ste 100 Maplewood MN 55109 | |
(651) 232-7800 | |
(651) 232-7826 |
Full Name | |
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Speciality | Clinic/center |
Location | 2945 Hazelwood St Ste 100, Maplewood, Minnesota |
Authorized Official Name and Position | Maureen Ring (DIRECTOR NETWORK RELATIONS AO) |
Authorized Official Contact | 6126726740 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2945 Hazelwood St Ste 100 Maplewood MN 55109-1242 Ph: (651) 232-7800 | 2945 Hazelwood St Ste 100 Maplewood MN 55109 Ph: (651) 232-7800 |
NPI Number | 1689616716 |
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Provider Enumeration Date | 06/12/2006 |
Last Update Date | 10/04/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1689616716 | NPI | - | NPPES |
640716100 | Medicaid | MN | |
0841630011 | Other | MN | MEDICARE PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
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 |