MEDICARE: PIIC CLINICAL SERVICES

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1508500844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIIC CLINICAL SERVICES

Provider Business Mailing Address
First Line	:	323 WASHINGTON AVE N STE 200
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-2206
Country	:	US
Telephone Number	:	952-698-9860
Fax Number	:	612-930-0106

Provider Business Practice Location Address
First Line	:	1 SCIMED PL # MSA170
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-1565
Country	:	US
Telephone Number	:	763-494-2278
Fax Number	:	833-972-1580

Authorized Official
Title or Position	:	CARE OPERATIONS MANAGER
Name	:	ALETHEA ANDERSON
Credential	:
Telephone Number	:	952-698-9860

Provider Enumeration Date	:	04/22/2022
Last Update Date	:	03/17/2025

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Directions to “PIIC CLINICAL SERVICES ” Practice Location

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