| Independent Medical Clinic Pa | |
|
2639 Nicollet Ave Ste 120 Minneapolis MN 55408-1629 | |
| (612) 315-5145 | |
| (855) 670-9121 |
| Full Name | Independent Medical Clinic Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 2639 Nicollet Ave Ste 120, Minneapolis, Minnesota |
| Authorized Official Name and Position | Patrick R Townley (OWNER) |
| Authorized Official Contact | 6122811298 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Independent Medical Clinic Pa 2639 Nicollet Ave Ste 120 Minneapolis MN 55408-1629 Ph: (612) 315-5145 | Independent Medical Clinic Pa 2639 Nicollet Ave Ste 120 Minneapolis MN 55408-1629 Ph: (612) 315-5145 |
| NPI Number | 1316454077 |
|---|---|
| Provider Enumeration Date | 01/03/2018 |
| Last Update Date | 06/20/2019 |
| Medicare PECOS PAC ID | 2264780923 |
|---|---|
| Medicare Enrollment ID | O20180813001840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316454077 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 44276 (Minnesota) | Primary |
| Provider Name | Patrick R. Townley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154488740 PECOS PAC ID: 4082752175 Enrollment ID: I20091110000555 |
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