| Humboldt Jr Sr Highschool Clinic | |
|
30 Baker St E Saint Paul MN 55107-2966 | |
| (651) 312-1996 | |
| (651) 312-1997 |
| Full Name | Humboldt Jr Sr Highschool Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 30 Baker St E, Saint Paul, Minnesota |
| Authorized Official Name and Position | Reuben Moore (CEO) |
| Authorized Official Contact | 6516027500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Humboldt Jr Sr Highschool Clinic 153 Cesar Chavez St Saint Paul MN 55107-2226 Ph: (651) 602-7500 | Humboldt Jr Sr Highschool Clinic 30 Baker St E Saint Paul MN 55107-2966 Ph: (651) 312-1996 |
| NPI Number | 1649394727 |
|---|---|
| Provider Enumeration Date | 03/16/2007 |
| Last Update Date | 05/15/2024 |
| Medicare PECOS PAC ID | 2062306434 |
|---|---|
| Medicare Enrollment ID | O20061117000238 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649394727 | NPI | - | NPPES |
| 522927000 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Minnesota) | Primary |
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