Healthcare Provider Details

I. General information

NPI: 1083778708
Provider Name (Legal Business Name): MEDICAL CARE SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LONG LAKE RD STE 106
NEW BRIGHTON MN
55112-6414
US

IV. Provider business mailing address

900 LONG LAKE RD STE 106
NEW BRIGHTON MN
55112-6414
US

V. Phone/Fax

Practice location:
  • Phone: 612-706-9630
  • Fax: 612-706-9617
Mailing address:
  • Phone: 612-706-9630
  • Fax: 612-706-9617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1490
License Number StateMN

VIII. Authorized Official

Name: DR. SPENCER ALLAN JOHNSON
Title or Position: VP
Credential: MD
Phone: 612-706-9630