MEDICARE: CEDAR RIVERSIDE PEOPLES CENTER

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	261QF0400X	Federally Qualified Health Center (FQHC)		MN

General Provider Information

NPI Number	:	1932427358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR RIVERSIDE PEOPLES CENTER

Provider Business Mailing Address
First Line	:	425 20TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-4400
Country	:	US
Telephone Number	:	612-332-4973
Fax Number	:	612-238-3534

Provider Business Practice Location Address
First Line	:	2823 E FRANKLIN AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1127
Country	:	US
Telephone Number	:	612-332-4973
Fax Number	:	612-238-3534

Authorized Official
Title or Position	:	CEO
Name	:	PEGGY METZER
Credential	:
Telephone Number	:	612-332-4973

Provider Enumeration Date	:	05/10/2010
Last Update Date	:	03/21/2011

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