| |
300 S 6th St Government Center-a 120 Minneapolis MN 55487-0070 | |
(612) 348-4628 | |
(612) 596-9984 |
Full Name | |
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Speciality | Clinic/center |
Location | 300 S 6th St, Minneapolis, Minnesota |
Authorized Official Name and Position | Derrick Hollings (C.F.O) |
Authorized Official Contact | 6128735340 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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701 Park Ave P1-finance Minneapolis MN 55415-1623 Ph: (612) 873-3000 | 300 S 6th St Government Center-a 120 Minneapolis MN 55487-0070 Ph: (612) 348-4628 |
NPI Number | 1528361573 |
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Provider Enumeration Date | 12/14/2010 |
Last Update Date | 03/23/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1528361573 | NPI | - | NPPES |
157245800 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 367142 (Minnesota) | Primary |
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