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NPI Code Detail

MEDICARE: KEY CORPORATION

MEDICARE: KEY CORPORATION
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
1251S00000XCommunity/Behavioral Health Agency
2225X00000XOccupational Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
36G530PROTHERMNBLUE CROSS BLUE SHIELD
4103288OTHERMNUCARE

General Provider Information

NPI Number : 1639239445
Entity Type Code : Organization
Provider Name (Legal Business Name) : KEY CORPORATION
Provider Business Mailing Address
First Line : 1394 JACKSON ST STE 201
Second Line :
City : SAINT PAUL
State : MN
Zip : 55117-4630
Country : US
Telephone Number : 651-603-8774
Fax Number : 651-603-9009
Provider Business Practice Location Address
First Line : 1394 JACKSON ST STE 201
Second Line :
City : SAINT PAUL
State : MN
Zip : 55117-4630
Country : US
Telephone Number : 651-603-8774
Fax Number : 651-603-9009
Authorized Official
Title or Position : ADMINISTRATOR
Name : MS. THERESA M BOWLIN
Credential :
Telephone Number : 651-784-7828
Provider Enumeration Date : 12/11/2006
Last Update Date : 03/13/2021

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1760286728 — KEY CORPORATION
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1053115071 — KEY CORPORATION
Practice Location Address:
1394 JACKSON ST STE 201
SAINT PAUL, MN
55117-4630
Practice Phone: 651-603-8774
Practice Fax: 855-293-1835

Directions to “KEY CORPORATION ” Practice Location

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