Healthcare Provider Details

I. General information

NPI: 1841332087
Provider Name (Legal Business Name): FAMILY HEALTHSERVICES MINNESOTA, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 UPPER AFTON RD E
MAPLEWOOD MN
55119-4780
US

IV. Provider business mailing address

9276 SCRANTON RD SUITE 100
SAN DIEGO CA
92121-7701
US

V. Phone/Fax

Practice location:
  • Phone: 651-739-5050
  • Fax:
Mailing address:
  • Phone: 858-625-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number26215
License Number StateMN

VIII. Authorized Official

Name: SCOTT PETERSON
Title or Position: CFO
Credential:
Phone: 858-625-2990