Robbinsdale Clinic, P.a. | |
3819 W Broadway Ave Robbinsdale MN 55422-2207 | |
(763) 533-2534 | |
Not Available |
Full Name | Robbinsdale Clinic, P.a. |
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Speciality | Family Medicine |
Location | 3819 W Broadway Ave, Robbinsdale, Minnesota |
Authorized Official Name and Position | Joyce A Johnson (OFFICE MANAGER) |
Authorized Official Contact | 7635332534 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Robbinsdale Clinic, P.a. Po Box 22220 Robbinsdale MN 55422-0220 Ph: (763) 533-2534 | Robbinsdale Clinic, P.a. 3819 W Broadway Ave Robbinsdale MN 55422-2207 Ph: (763) 533-2534 |
NPI Number | 1316022395 |
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Provider Enumeration Date | 10/26/2006 |
Last Update Date | 03/02/2010 |
Medicare PECOS PAC ID | 7012904535 |
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Medicare Enrollment ID | O20040427001437 |
Identifier | Type | State | Issuer |
---|---|---|---|
1316022395 | NPI | - | NPPES |
075310600 | Medicaid | MN | |
24D0402400 | Other | MN | CLIA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 684 (Minnesota) | Primary |
Provider Name | June M Fahrmann |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1659456705 PECOS PAC ID: 6406843937 Enrollment ID: I20110405000224 |
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