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1349 Arcade St Saint Paul MN 55106-1801 | |
(651) 778-2889 | |
(651) 778-2890 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1349 Arcade St, 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 |
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153 Cesar Chavez St Saint Paul MN 55107-2226 Ph: (651) 602-7500 | 1349 Arcade St Saint Paul MN 55106-1801 Ph: (651) 778-2889 |
NPI Number | 1083765135 |
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Provider Enumeration Date | 01/16/2007 |
Last Update Date | 05/15/2024 |
Medicare PECOS PAC ID | 2062306434 |
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Medicare Enrollment ID | O20061117000245 |
Identifier | Type | State | Issuer |
---|---|---|---|
1083765135 | NPI | - | NPPES |
523083700 | Medicaid | MN | |
103124 | Other | MN | UCARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Minnesota) | Primary |
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 |