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265 Creek Ln S Jordan MN 55352-1214 | |
(952) 428-1200 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 265 Creek Ln S, Jordan, Minnesota |
Authorized Official Name and Position | Amy Jerdee (PRESIDENT) |
Authorized Official Contact | 9524282400 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 43 Mail Route 10860 Minneapolis MN 55440-0043 Ph: (612) 262-1166 | 265 Creek Ln S Jordan MN 55352-1214 Ph: (952) 428-1200 |
NPI Number | 1972857597 |
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Provider Enumeration Date | 11/05/2012 |
Last Update Date | 04/30/2024 |
Medicare PECOS PAC ID | 7214821909 |
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Medicare Enrollment ID | O20130507000549 |
Identifier | Type | State | Issuer |
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1972857597 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |