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NPI Code Detail

MEDICARE: PRIMARY CARE & REHABILITATION CLINICS, INC.

MEDICARE: PRIMARY CARE & REHABILITATION CLINICS, INC.
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
1261QM1300XMulti-Specialty Clinic/CenterMN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13C060TEOTHERMNBCBS D.C. PROV #
22M391TEOTHERMNBCBS MD PROVIDER #
38B610TEOTHERMNBCBS PT PROVIDER #

General Provider Information

NPI Number : 1306842547
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMARY CARE & REHABILITATION CLINICS, INC.
Provider Business Mailing Address
First Line : 3015 UTAH AVE S
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55426-3671
Country : US
Telephone Number : 952-933-8900
Fax Number : 952-945-9536
Provider Business Practice Location Address
First Line : 3015 UTAH AVE S
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55426-3671
Country : US
Telephone Number : 952-933-8900
Fax Number : 952-945-9536
Authorized Official
Title or Position : PRESIDENT
Name : LEON B FRID
Credential : D.C.
Telephone Number : 952-933-8900
Provider Enumeration Date : 06/22/2005
Last Update Date : 08/22/2020

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Directions to “PRIMARY CARE & REHABILITATION CLINICS, INC. ” Practice Location

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