| St. Croix Family Medical Clinic | |
|
5640 Memorial Ave N Suite B Stillwater MN 55082-2166 | |
| (651) 430-1880 | |
| (651) 430-1323 |
| Full Name | St. Croix Family Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 5640 Memorial Ave N, Stillwater, Minnesota |
| Authorized Official Name and Position | William Henry Tendle (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6128212800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Croix Family Medical Clinic 4243 4th Ave S Minneapolis MN 55409-2113 Ph: (612) 822-9030 | St. Croix Family Medical Clinic 5640 Memorial Ave N Suite B Stillwater MN 55082-2166 Ph: (651) 430-1880 |
| NPI Number | 1578680872 |
|---|---|
| Provider Enumeration Date | 03/23/2007 |
| Last Update Date | 04/30/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578680872 | NPI | - | NPPES |
| 943170500 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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