| Provax Llc | |
|
2018 Stone Creek Dr Chanhassen MN 55317-7410 | |
| (952) 470-6005 | |
| Not Available |
| Full Name | Provax Llc |
|---|---|
| Speciality | Clinic/center - Community Health |
| Location | 2018 Stone Creek Dr, Chanhassen, Minnesota |
| Authorized Official Name and Position | Cindy L Egelston (OWNER) |
| Authorized Official Contact | 9524706005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provax Llc 2018 Stone Creek Dr Chanhassen MN 55317-7410 Ph: (952) 470-6005 | Provax Llc 2018 Stone Creek Dr Chanhassen MN 55317-7410 Ph: (952) 470-6005 |
| NPI Number | 1619202934 |
|---|---|
| Provider Enumeration Date | 10/05/2009 |
| Last Update Date | 10/05/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619202934 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | R106374-5 (Minnesota) | Primary |
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