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NPI Code Detail

MEDICARE: AMHERST H. WILDER FOUNDATION

MEDICARE: AMHERST H. WILDER FOUNDATION
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
1251B00000XCase Management Agency
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1555055600OTHERMNMEDICAL ASSISTANCE

General Provider Information

NPI Number : 1548337355
Entity Type Code : Organization
Provider Name (Legal Business Name) : AMHERST H. WILDER FOUNDATION
Provider Business Mailing Address
First Line : 451 LEXINGTON PKWY N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-4636
Country : US
Telephone Number : 651-280-2310
Fax Number : 651-280-3995
Provider Business Practice Location Address
First Line : 451 LEXINGTON PKWY N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-4636
Country : US
Telephone Number : 651-280-2000
Fax Number : 651-280-2310
Authorized Official
Title or Position : VICE PRESIDENT ADMINISTRATION
Name : MORRIS GOODWIN
Credential :
Telephone Number : 651-280-2310
Provider Enumeration Date : 11/29/2006
Last Update Date : 10/03/2012

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Directions to “AMHERST H. WILDER FOUNDATION ” Practice Location

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