Healthcare Provider Details

I. General information

NPI: 1942816533
Provider Name (Legal Business Name): SAINT CLOUD PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 42ND AVE S STE 100
SAINT CLOUD MN
56301-6251
US

IV. Provider business mailing address

13905 HUMMINGBIRD LN
COLD SPRING MN
56320-9824
US

V. Phone/Fax

Practice location:
  • Phone: 320-291-5595
  • Fax: 320-227-5025
Mailing address:
  • Phone: 320-291-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WEINING HU
Title or Position: PRESIDENT
Credential: MD
Phone: 320-291-5595