| |
1500 James Ave N Minneapolis MN 55411-3161 | |
(612) 668-1740 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1500 James Ave N, Minneapolis, Minnesota |
Authorized Official Name and Position | Baye D Diouf (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 6125432545 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1256 Penn Ave N Ste 5100 Minneapolis MN 55411-2617 Ph: (612) 543-2545 | 1500 James Ave N Minneapolis MN 55411-3161 Ph: (612) 668-1740 |
NPI Number | 1205145448 |
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Provider Enumeration Date | 10/06/2010 |
Last Update Date | 09/24/2024 |
Medicare PECOS PAC ID | 7911892849 |
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Medicare Enrollment ID | O20110113000364 |
Identifier | Type | State | Issuer |
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1205145448 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Primary |
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