| Pediatric Services Pa | |
|
4700 Park Glen Rd St Louis Park MN 55416-5701 | |
| (952) 922-4200 | |
| (952) 922-4301 |
| Full Name | Pediatric Services Pa |
|---|---|
| Speciality | Clinic/center |
| Location | 4700 Park Glen Rd, St Louis Park, Minnesota |
| Authorized Official Name and Position | Jennifer Zerba (ADMINISTRATIVE OFFICE MANAGER) |
| Authorized Official Contact | 9529224200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Services Pa 4700 Park Glen Rd St Louis Park MN 55416-5701 Ph: (952) 922-4200 | Pediatric Services Pa 4700 Park Glen Rd St Louis Park MN 55416-5701 Ph: (952) 922-4200 |
| NPI Number | 1962553917 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 03/10/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962553917 | NPI | - | NPPES |
| 485010600 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1056 (Minnesota) | Primary |
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