| Kingsley Clinic Of Minnesota, Pllc | |
|
333 Washington Ave N Ste 300 Minneapolis MN 55401-1353 | |
| (612) 453-1907 | |
| (612) 500-4916 |
| Full Name | Kingsley Clinic Of Minnesota, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 333 Washington Ave N Ste 300, Minneapolis, Minnesota |
| Authorized Official Name and Position | James Kingsley (OWNER) |
| Authorized Official Contact | 6124531907 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kingsley Clinic Of Minnesota, Pllc 333 Washington Ave N Ste 300 Minneapolis MN 55401-1353 Ph: (612) 453-1907 | Kingsley Clinic Of Minnesota, Pllc 333 Washington Ave N Ste 300 Minneapolis MN 55401-1353 Ph: (612) 453-1907 |
| NPI Number | 1255939716 |
|---|---|
| Provider Enumeration Date | 10/15/2020 |
| Last Update Date | 04/26/2023 |
| Medicare PECOS PAC ID | 5698176790 |
|---|---|
| Medicare Enrollment ID | O20210628000811 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255939716 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | James Ralph Kingsley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841687142 PECOS PAC ID: 8325316326 Enrollment ID: I20210628001160 |
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