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233 Radio Dr Woodbury MN 55125-5805 | |
| (651) 254-7400 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 233 Radio Dr, Woodbury, Minnesota |
| Authorized Official Name and Position | John Clark (VICE PRESIDENT, FINANCE) |
| Authorized Official Contact | 6512540900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
640 Jackson St Saint Paul MN 55101-2502 Ph: () - | 233 Radio Dr Woodbury MN 55125-5805 Ph: (651) 254-7400 |
| NPI Number | 1104681105 |
|---|---|
| Provider Enumeration Date | 02/19/2024 |
| Last Update Date | 02/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104681105 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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