Healthcare Provider Details

I. General information

NPI: 1437218740
Provider Name (Legal Business Name): SOUTHERN CITIES COMMUNITY HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 4TH ST NW
FARIBAULT MN
55021-5031
US

IV. Provider business mailing address

3200 LABORE RD STE 104
VADNAIS HEIGHTS MN
55110-5186
US

V. Phone/Fax

Practice location:
  • Phone: 507-384-6830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MELISSA ELLS
Title or Position: AMBULATORY CARE EXECUTIVE DIRECTOR
Credential: PHARMD
Phone: 651-539-7200