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General NPI Number Information
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NPI Number | 1437218740
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Entity Type | Organization
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Legal Business Name | SOUTHERN CITIES COMMUNITY HEALTH CLINIC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 400 4TH ST NW
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City | FARIBAULT
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State | MN
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Zip | 55021-5031
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Country | US
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Telephone | 507-384-6830
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 LABORE RD STE 104
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55110-5186
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AMBULATORY CARE EXECUTIVE DIRECTOR
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Name | MELISSA ELLS
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Credential | PHARMD
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Telephone | 651-539-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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