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NPI Code Detail

MEDICARE: PJG MEDICAL L.L.C.

MEDICARE: PJG MEDICAL L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0100XHealth Service Clinic/Center

General Provider Information

NPI Number : 1285241075
Entity Type Code : Organization
Provider Name (Legal Business Name) : PJG MEDICAL L.L.C.
Provider Business Mailing Address
First Line : 700 RAYMOND AVE STE 130
Second Line :
City : SAINT PAUL
State : MN
Zip : 55114-1778
Country : US
Telephone Number : 612-895-1510
Fax Number : 833-979-0945
Provider Business Practice Location Address
First Line : 700 RAYMOND AVE STE 130
Second Line :
City : SAINT PAUL
State : MN
Zip : 55114-1778
Country : US
Telephone Number : 612-895-1510
Fax Number : 833-979-0945
Authorized Official
Title or Position : OWNER
Name : PHILIP GYURA
Credential : NP
Telephone Number : 507-398-2481
Provider Enumeration Date : 09/25/2020
Last Update Date : 12/16/2021

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Directions to “PJG MEDICAL L.L.C. ” Practice Location

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