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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
1261QF0400XFederally Qualified Health Center (FQHC)302133MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
129548WEOTHERMNBCBS
2109057OTHERMNHEALTHPARTNERS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4104403OTHERMNUCARE

General Provider Information

NPI Number : 1437118619
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 : 651-602-7513
Provider Business Practice Location Address
First Line : 153 CESAR CHAVEZ ST
Second Line :
City : SAINT PAUL
State : MN
Zip : 55107-2226
Country : US
Telephone Number : 651-222-1816
Fax Number : 651-602-7517
Authorized Official
Title or Position : CEO
Name : REUBEN MOORE
Credential :
Telephone Number : 651-602-7500
Provider Enumeration Date : 03/17/2006
Last Update Date : 05/15/2024

Similar Medicare Providers

1104820661 — CARRIE S DICKSON CNM
Practice Location Address:
153 CESAR CHAVEZ ST
SAINT PAUL, MN
55107-2226
Practice Phone: 651-602-7509
Practice Fax:
1871587626 — DR. DANIEL JOHN REHRAUER PHARMD
Practice Location Address:
153 CESAR CHAVEZ ST
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Practice Phone: 651-602-7589
Practice Fax:
1518936434 — DR. DEANNA M GENGLER
Practice Location Address:
153 CESAR CHAVEZ ST
SAINT PAUL, MN
55107-2226
Practice Phone: 651-602-7589
Practice Fax:
1336118520 — DENNIS BEALKA M.D.
Practice Location Address:
153 CESAR CHAVEZ ST
SAINT PAUL, MN
55107-2226
Practice Phone: 651-222-1816
Practice Fax: 651-602-7517
1518926773 — ANGELA BERGMANN M.D.
Practice Location Address:
153 CESAR CHAVEZ ST
SAINT PAUL, MN
55107-2226
Practice Phone: 651-222-1816
Practice Fax: 651-602-7517
1467411173 — RENE PELLETIER M.D.
Practice Location Address:
153 CESAR CHAVEZ ST
SAINT PAUL, MN
55107-2226
Practice Phone: 651-222-1816
Practice Fax: 651-602-7517

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

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