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2315 Como Ave Saint Paul MN 55108-1723 | |
(651) 646-2549 | |
(651) 646-2480 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 2315 Como Ave, Saint Paul, Minnesota |
Authorized Official Name and Position | David Lee Gilbertson (PRESIDENT) |
Authorized Official Contact | 6516462549 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2315 Como Ave Saint Paul MN 55108-1723 Ph: (651) 646-2549 | 2315 Como Ave Saint Paul MN 55108-1723 Ph: (651) 646-2549 |
NPI Number | 1265547533 |
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Provider Enumeration Date | 08/20/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265547533 | NPI | - | NPPES |
25Y48AN | Other | MN | BLUECROSS BLUESHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 6251520 (Minnesota) | Primary |
Premiere Mental Health Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 360 Sherman St Ste 290, Saint Paul, MN 55102 Phone: 763-913-8125 |