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225 Smith Ave N Suite 300 Saint Paul MN 55102-2533 | |
(651) 726-6219 | |
(651) 726-6201 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 225 Smith Ave N, Saint Paul, Minnesota |
Authorized Official Name and Position | Dennis Wipperling (PRACTICE ADMINISTRATOR) |
Authorized Official Contact | 6517266219 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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225 Smith Ave N Suite 300 Saint Paul MN 55102-2533 Ph: (651) 726-9219 | 225 Smith Ave N Suite 300 Saint Paul MN 55102-2533 Ph: (651) 726-6219 |
NPI Number | 1376595033 |
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Provider Enumeration Date | 05/17/2006 |
Last Update Date | 06/22/2012 |
Identifier | Type | State | Issuer |
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1376595033 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | 822 (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 |