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NPI Code Detail

MEDICARE: WEST SIDE COMMUNITY HEALTH SERVICES, INC.

MEDICARE: WEST SIDE COMMUNITY HEALTH SERVICES, 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
1261QD0000XDental Clinic/Center302133MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417007436
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Provider Business Mailing Address
First Line : 153 CESAR CHAVEZ ST
Second Line :
City : SAINT PAUL
State : MN
Zip : 55107-2226
Country : US
Telephone Number : 651-602-7500
Fax Number : 651-602-7500
Provider Business Practice Location Address
First Line : 478 ROBERT ST S
Second Line :
City : SAINT PAUL
State : MN
Zip : 55107-2236
Country : US
Telephone Number : 651-602-7575
Fax Number : 651-602-7518
Authorized Official
Title or Position : CEO
Name : REUBEN MOORE
Credential :
Telephone Number : 651-602-7500
Provider Enumeration Date : 01/11/2007
Last Update Date : 05/15/2024

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Directions to “WEST SIDE COMMUNITY HEALTH SERVICES, INC. ” Practice Location

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