| Mncome, Pa | |
|
1185 Town Centre Dr Suite 220 Eagan MN 55123-1187 | |
| (651) 379-1600 | |
| (651) 379-1650 |
| Full Name | Mncome, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 1185 Town Centre Dr, Eagan, Minnesota |
| Authorized Official Name and Position | Rebecca Gonzalez-campoy (COO) |
| Authorized Official Contact | 6513791600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mncome, Pa 1185 Town Centre Dr Suite 220 Eagan MN 55123-1187 Ph: (651) 379-1600 | Mncome, Pa 1185 Town Centre Dr Suite 220 Eagan MN 55123-1187 Ph: (651) 379-1600 |
| NPI Number | 1164477709 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 02/06/2013 |
| Medicare PECOS PAC ID | 3971496761 |
|---|---|
| Medicare Enrollment ID | O20040205000433 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164477709 | NPI | - | NPPES |
| DB4333 | Other | MN | RR MEDICARE |
| 410654700 | Medicaid | MN | |
| 96386 | Other | MN | HEALTHPARTNERS |
| 165867H314 | Other | MN | UCARE |
| 547S0MI | Other | MN | BLUE CROSS BLUE SHIELD |
| C03334 | Other | MN | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 1591 (Minnesota) | Secondary |
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | 1591 (Minnesota) | Primary |
| Provider Name | Joseph Michael Gonzalez-campoy |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1720033640 PECOS PAC ID: 1951294750 Enrollment ID: I20040420001108 |
| Provider Name | Catherine B Proebstle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568456168 PECOS PAC ID: 4587601240 Enrollment ID: I20050413001244 |
| Provider Name | Bruce W Richardson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699736066 PECOS PAC ID: 2567505324 Enrollment ID: I20100203000038 |
| Provider Name | Bronwyn Lissa Knaebe |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1821594656 PECOS PAC ID: 8628332699 Enrollment ID: I20180430001386 |
| Provider Name | Virginia Otey Villarreal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518583590 PECOS PAC ID: 0042639379 Enrollment ID: I20201006000705 |
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