Organization Name: | ST PAUL PRIMARY CARE |
NPI Number: | 1770972382 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KAREN LEE (MD) |
Mailing Address: | 1345 Thompson Ave South St Paul |
State: | MN US |
Postal Code: | 550751410 |
Phone Number: | 6514512711 |
Fax Number: | |
NPI Enumeration Date: | 01/20/2015 |
NPI Last Update Date: | 01/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 43414 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |