MEDICARE: FAMILY HEALTHSERVICES MINNESOTA, P.A.

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
1	332900000X	Non-Pharmacy Dispensing Site	28848	MN

General Provider Information

NPI Number	:	1427190537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTHSERVICES MINNESOTA, P.A.

Provider Business Mailing Address
First Line	:	5810 NANCY RIDGE DR
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2834
Country	:	US
Telephone Number	:	858-625-2990
Fax Number	:

Provider Business Practice Location Address
First Line	:	1814 N SAINT PAUL RD
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-4700
Country	:	US
Telephone Number	:	651-777-8393
Fax Number	:

Authorized Official
Title or Position	:	DIR. OF OPERATIONS
Name	:	KENNY HEINE
Credential	:
Telephone Number	:	858-625-2990

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	11/04/2009

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