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NPI Code Detail

MEDICARE: HENNEPIN COUNTY

MEDICARE: HENNEPIN COUNTY
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)

General Provider Information

NPI Number : 1700357779
Entity Type Code : Organization
Provider Name (Legal Business Name) : HENNEPIN COUNTY
Provider Business Mailing Address
First Line : 525 PORTLAND AVE # MC963
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55415-1533
Country : US
Telephone Number : 612-348-5553
Fax Number : 612-677-6299
Provider Business Practice Location Address
First Line : 2211 CLINTON AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3656
Country : US
Telephone Number : 612-348-5553
Fax Number : 612-677-6299
Authorized Official
Title or Position : AREA MANAGER
Name : STEPHANIE ABEL
Credential :
Telephone Number : 612-348-8824
Provider Enumeration Date : 12/17/2018
Last Update Date : 12/19/2018

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Directions to “HENNEPIN COUNTY ” Practice Location

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