Healthsource Of St. Paul- Grand | |
1053 Grand Ave Suite #114 Saint Paul MN 55105-3022 | |
(651) 292-9247 | |
(651) 292-9257 |
Full Name | Healthsource Of St. Paul- Grand |
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Speciality | Clinic/Center |
Location | 1053 Grand Ave, Saint Paul, Minnesota |
Authorized Official Name and Position | Christopher Thomas Drews (PRESIDENT) |
Authorized Official Contact | 6512929247 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Healthsource Of St. Paul- Grand 1053 Grand Ave Suite #114 Saint Paul MN 55105-3022 Ph: (651) 292-9247 | Healthsource Of St. Paul- Grand 1053 Grand Ave Suite #114 Saint Paul MN 55105-3022 Ph: (651) 292-9247 |
NPI Number | 1154696813 |
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Provider Enumeration Date | 03/14/2012 |
Last Update Date | 03/30/2012 |
Medicare PECOS PAC ID | 5496985962 |
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Medicare Enrollment ID | O20140228001113 |
Identifier | Type | State | Issuer |
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1154696813 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | DC4257 (Minnesota) | Primary |
Provider Name | Bethany Ann Fluto |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1811357528 PECOS PAC ID: 4183921158 Enrollment ID: I20160318001843 |
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 |