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General NPI Number Information
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NPI Number | 1932316916
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Entity Type | Organization
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Legal Business Name | PEDIATRIC AND YOUNG ADULT MEDICINE, PA
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 1804 7TH ST W SUITE 200
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City | SAINT PAUL
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State | MN
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Zip | 55116-2300
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Country | US
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Telephone | 651-227-7806
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Fax | 651-256-6766
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Provider Business Mailing Address
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Address Line | 1804 7TH ST W SUITE 200
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City | SAINT PAUL
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State | MN
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Zip | 55116-2300
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Country | US
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Telephone | 651-227-7806
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Fax | 651-256-6766
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | MS. TERRI M JOSEPH
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Credential |
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Telephone | 651-256-6706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 154
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License Number State | MN
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