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2426 W Broadway Ave Minneapolis MN 55411-1735 | |
(612) 302-8200 | |
(612) 302-8275 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 2426 W Broadway Ave, Minneapolis, Minnesota |
Authorized Official Name and Position | William Sibert (CFO) |
Authorized Official Contact | 3125605317 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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720 Washington Ave Se Ste 200 Minneapolis MN 55414-2924 Ph: (612) 884-0600 | 2426 W Broadway Ave Minneapolis MN 55411-1735 Ph: (612) 302-8200 |
NPI Number | 1366589962 |
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Provider Enumeration Date | 01/31/2007 |
Last Update Date | 12/04/2024 |
Identifier | Type | State | Issuer |
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1366589962 | NPI | - | NPPES |
701372800 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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