Healthcare Provider Details

I. General information

NPI: 1376769778
Provider Name (Legal Business Name): OPEN CITIES HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 RICE STREET
ST. PAUL MN
55117-5425
US

IV. Provider business mailing address

409 N DUNLAP STREET
ST. PAUL MN
55104-4201
US

V. Phone/Fax

Practice location:
  • Phone: 651-290-9200
  • Fax: 651-290-9210
Mailing address:
  • Phone: 651-489-8021
  • Fax: 651-489-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number3432431
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: FRANCES GREEN
Title or Position: HR
Credential:
Phone: 651-290-2111