| Superior Performance Center Sports Medicine, Pain, Spine, Rehabilitat | |
|
9220 Bass Lake Rd Suite 350 New Hope MN 55428-3095 | |
| (763) 208-9545 | |
| (651) 927-8668 |
| Full Name | Superior Performance Center Sports Medicine, Pain, Spine, Rehabilitat |
|---|---|
| Speciality | Clinic/Center |
| Location | 9220 Bass Lake Rd, New Hope, Minnesota |
| Authorized Official Name and Position | Serge B Pierrecharles (OWNER) |
| Authorized Official Contact | 6462343795 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Superior Performance Center Sports Medicine, Pain, Spine, Rehabilitat 9220 Bass Lake Rd Suite 350 New Hope MN 55428-3095 Ph: (763) 208-9545 | Superior Performance Center Sports Medicine, Pain, Spine, Rehabilitat 9220 Bass Lake Rd Suite 350 New Hope MN 55428-3095 Ph: (763) 208-9545 |
| NPI Number | 1083124010 |
|---|---|
| Provider Enumeration Date | 10/04/2017 |
| Last Update Date | 03/25/2020 |
| Medicare PECOS PAC ID | 8820355050 |
|---|---|
| Medicare Enrollment ID | O20171127001269 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083124010 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 58656 (Minnesota) | Primary |
| Provider Name | Serge B Pierrecharles |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1609167980 PECOS PAC ID: 3375850852 Enrollment ID: I20161031001502 |
| Provider Name | Lee Chisholm |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1306314117 PECOS PAC ID: 0941548564 Enrollment ID: I20210819001024 |
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