Healthcare Provider Details

I. General information

NPI: 1962408906
Provider Name (Legal Business Name): OPEN CITIES HEALTH CENTER, INC. - RICE STREET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 RICE STREET
ST. PAUL MN
55117
US

IV. Provider business mailing address

409 NORTH DUNLAP STREET
ST. PAUL MN
55104
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number052730
License Number StateMN

VIII. Authorized Official

Name: JAMES PLATTEN
Title or Position: CEO
Credential:
Phone: 651-290-9245