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NPI Code Detail

MEDICARE: CHILDREN'S HEALTH CARE

MEDICARE: CHILDREN'S HEALTH CARE
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
1261QP2300XPrimary Care Clinic/Center347125MN

General Provider Information

NPI Number : 1477869311
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN'S HEALTH CARE
Provider Business Mailing Address
First Line : 2910 CENTRE POINTE DR
Second Line :
City : ROSEVILLE
State : MN
Zip : 55113-1182
Country : US
Telephone Number : 651-855-2109
Fax Number : 651-855-2310
Provider Business Practice Location Address
First Line : 4520 CENTERVILLE RD
Second Line :
City : VADNAIS HEIGHTS
State : MN
Zip : 55127-3602
Country : US
Telephone Number : 651-426-1141
Fax Number :
Authorized Official
Title or Position : CFO
Name : JERRY L MASSMANN
Credential :
Telephone Number : 612-813-6113
Provider Enumeration Date : 08/30/2010
Last Update Date : 10/31/2022

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Directions to “CHILDREN'S HEALTH CARE ” Practice Location

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