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1307 Maynard Dr W Suite 13 Saint Paul MN 55116-2930 | |
(651) 699-2093 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 1307 Maynard Dr W, Saint Paul, Minnesota |
Authorized Official Name and Position | Ann Nyakundi (CEO) |
Authorized Official Contact | 6512411084 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1026 7th St W Saint Paul MN 55102-3828 Ph: (651) 241-1000 | 1307 Maynard Dr W Suite 13 Saint Paul MN 55116-2930 Ph: (651) 699-2093 |
NPI Number | 1942384193 |
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Provider Enumeration Date | 10/24/2006 |
Last Update Date | 03/12/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942384193 | NPI | - | NPPES |
NA398 | Other | MN | PREFERRED ONE |
DB2459 | Other | MN | RAILROAD MEDICARE |
164690 | Other | MN | UCARE |
282M2UN | Other | MN | BLUE CROSS |
697442000 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | 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 |