MEDICARE: SOUTH METRO HUMAN SERVICES DBA RADIAS HEALTH

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	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871664722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH METRO HUMAN SERVICES DBA RADIAS HEALTH

Provider Business Mailing Address
First Line	:	2021 EAST HENNEPIN AVE
Second Line	:	SUITE 330
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413
Country	:	US
Telephone Number	:	612-435-7200
Fax Number	:	612-435-7201

Provider Business Practice Location Address
First Line	:	2021 E HENNEPIN AVE
Second Line	:	SUITE 330
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2700
Country	:	US
Telephone Number	:	612-435-7200
Fax Number	:	612-435-7201

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TOM PAUL
Credential	:
Telephone Number	:	651-256-1234

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	10/26/2018

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