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225 Smith Ave N Ste 400 St Paul MN 55102-2568 | |
(651) 241-7176 | |
(651) 241-5100 |
Full Name | |
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Speciality | Clinic/center |
Location | 225 Smith Ave N Ste 400, St Paul, Minnesota |
Authorized Official Name and Position | Dominica Tallarico (COO) |
Authorized Official Contact | 6122222222 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 43 Mail Route 10860 Minneapolis MN 55440-0043 Ph: (612) 262-1166 | 225 Smith Ave N Ste 400 St Paul MN 55102-2568 Ph: (651) 241-7176 |
NPI Number | 1518173319 |
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Provider Enumeration Date | 05/16/2007 |
Last Update Date | 03/22/2024 |
Identifier | Type | State | Issuer |
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1518173319 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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