Organization Name: | CHILDREN'S CLINIC NETWORK |
NPI Number: | 1346513447 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JERRY MASSMANN (CFO) |
Mailing Address: | 1547 Livingston Ave West St Paul |
State: | MN US |
Postal Code: | 551183411 |
Phone Number: | 6514518050 |
Fax Number: | 6515521575 |
NPI Enumeration Date: | 02/21/2012 |
NPI Last Update Date: | 02/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |