MEDICARE: HENNEPIN COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1841761954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENNEPIN COUNTY

Provider Business Mailing Address
First Line	:	525 PORTLAND AVE # MC963
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55415-1533
Country	:	US
Telephone Number	:	612-348-5553
Fax Number	:	612-677-6299

Provider Business Practice Location Address
First Line	:	3111 FIRST AVE. SO.
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2055
Country	:	US
Telephone Number	:	612-348-5553
Fax Number	:	612-677-6299

Authorized Official
Title or Position	:	AREA MANAGER
Name	:	STEPHANIE ABEL
Credential	:
Telephone Number	:	612-348-8824

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	09/16/2019

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Directions to “HENNEPIN COUNTY ” Practice Location

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