| Minnesota Craniofacial Center P.c. | |
|
2550 University Ave W Suite 143n Saint Paul MN 55114-1052 | |
| (651) 642-1013 | |
| (651) 642-0947 |
| Full Name | Minnesota Craniofacial Center P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2550 University Ave W, Saint Paul, Minnesota |
| Authorized Official Name and Position | Kim Marie Ledermann (DENTIST/OWNER) |
| Authorized Official Contact | 6516421013 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Minnesota Craniofacial Center P.c. 2550 University Ave W Suite 143n Saint Paul MN 55114-1052 Ph: (651) 642-1013 | Minnesota Craniofacial Center P.c. 2550 University Ave W Suite 143n Saint Paul MN 55114-1052 Ph: (651) 642-1013 |
| NPI Number | 1104160480 |
|---|---|
| Provider Enumeration Date | 11/26/2012 |
| Last Update Date | 06/11/2015 |
| Medicare PECOS PAC ID | 8921314857 |
|---|---|
| Medicare Enrollment ID | O20150908002225 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104160480 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 11715 (Minnesota) | Primary |
Saint Paul Physicians Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2300 Saint Clair Ave, Saint Paul, MN 55105 Phone: 651-291-1269 Fax: 651-291-0957 | |
Guadalupe Alternative Program(gap) Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 381 Robie St E, Saint Paul, MN 55107 Phone: 651-602-7976 Fax: 651-602-7977 | |
East Metro - North St. Paul Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2601 Centennial Dr, Suite 100, Saint Paul, MN 55109 Phone: 651-777-7414 Fax: 651-748-5839 | |
Family Health & Wellness Centers Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4520 Centerville Rd, Saint Paul, MN 55127 Phone: 651-348-8851 | |
Metropolitan Medical Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17 Exchange St W, Suite # 420, Saint Paul, MN 55102 Phone: 651-232-4125 Fax: 651-232-4127 | |
Central High School Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 275 Lexington Pkwy N, Saint Paul, MN 55104 Phone: 651-632-2194 Fax: 651-632-2195 | |
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 |