Pediatric And Young Adult Medicine, Pa | |
1655 Beam Ave Suite 108 Maplewood MN 55109-1163 | |
(651) 256-6706 | |
(651) 256-6707 |
Full Name | Pediatric And Young Adult Medicine, Pa |
---|---|
Speciality | Clinic/center - Primary Care |
Location | 1655 Beam Ave, Maplewood, Minnesota |
Authorized Official Name and Position | Terri M Joseph (CLINIC ADMINISTRATOR) |
Authorized Official Contact | 6512566706 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Pediatric And Young Adult Medicine, Pa 1804 7th St W Suite 200 Saint Paul MN 55116-2300 Ph: (651) 256-6706 | Pediatric And Young Adult Medicine, Pa 1655 Beam Ave Suite 108 Maplewood MN 55109-1163 Ph: (651) 256-6706 |
NPI Number | 1295977395 |
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Provider Enumeration Date | 04/03/2009 |
Last Update Date | 12/07/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295977395 | NPI | - | NPPES |
1477870921 | Medicaid | MN | |
1083694046 | Medicaid | MN | |
1245210095 | Medicaid | MN | |
1245210210 | Medicaid | MN | |
1104806165 | Medicaid | MN | |
1861558835 | Medicaid | MN | |
1881057065 | Medicaid | MN | |
1386991339 | Medicaid | MN | |
1497735419 | Medicaid | MN | |
1912987900 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 154 (Minnesota) | Primary |
Polaris Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2053 Woodlynn Ave, Maplewood, MN 55109 Phone: 651-431-0047 | |
My Medical Clinic Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1560 Beam Ave, Maplewood, MN 55109 Phone: 651-484-6923 |