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559 Capitol Blvd 6th Floor - Clinics Administration Saint Paul MN 55103-2101 | |
(651) 232-1699 | |
(651) 232-2009 |
Full Name | |
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Speciality | Clinic/center |
Location | 559 Capitol Blvd, 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 |
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559 Capitol Blvd 6th Floor - Clinics Administration Saint Paul MN 55103-2101 Ph: (651) 232-1699 | 559 Capitol Blvd 6th Floor - Clinics Administration Saint Paul MN 55103-2101 Ph: (651) 232-1699 |
NPI Number | 1740236603 |
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Provider Enumeration Date | 05/25/2006 |
Last Update Date | 05/20/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740236603 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
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 |