| Indian Health Board Of Minneapolis, Inc | |
|
1315 E 24th St Minneapolis MN 55404-3975 | |
| (612) 721-9800 | |
| (612) 721-7870 |
| Full Name | Indian Health Board Of Minneapolis, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1315 E 24th St, Minneapolis, Minnesota |
| Authorized Official Name and Position | Patrick Rock (CEO) |
| Authorized Official Contact | 6127219881 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indian Health Board Of Minneapolis, Inc 1315 E 24th St Minneapolis MN 55404-3975 Ph: (612) 721-9800 | Indian Health Board Of Minneapolis, Inc 1315 E 24th St Minneapolis MN 55404-3975 Ph: (612) 721-9800 |
| NPI Number | 1811999162 |
|---|---|
| Provider Enumeration Date | 06/01/2005 |
| Last Update Date | 01/19/2011 |
| Medicare PECOS PAC ID | 6002727849 |
|---|---|
| Medicare Enrollment ID | O20030725000017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811999162 | NPI | - | NPPES |
| 844522200 | Medicaid | MN | |
| 916817600 | Medicaid | MN | |
| 946883800 | Medicaid | MN | |
| 634930700 | Medicaid | MN | |
| 730320300 | Medicaid | MN | |
| 781137300 | Medicaid | MN | |
| 138488100 | Medicaid | MN | |
| 934633300 | Medicaid | MN | |
| 125028100 | Medicaid | MN | |
| 206817600 | Medicaid | MN | |
| 996488600 | Medicaid | MN | |
| 942317600 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 6115875 (Minnesota) | Primary |
| Provider Name | Melodie A Kabanuk-dohm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578029757 PECOS PAC ID: 8123359510 Enrollment ID: I20191016002174 |
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