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NPI Code Detail

MEDICARE: ST. PAUL CAPITAL AREA IRTS LLC

MEDICARE: ST. PAUL CAPITAL AREA IRTS LLC
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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1952118127
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. PAUL CAPITAL AREA IRTS LLC
Provider Business Mailing Address
First Line : 615 PARK ST
Second Line :
City : SAINT PAUL
State : MN
Zip : 55103-1826
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 615 PARK ST
Second Line :
City : SAINT PAUL
State : MN
Zip : 55103-1826
Country : US
Telephone Number : 612-470-6531
Fax Number :
Authorized Official
Title or Position : OWNER
Name : BIBI ABDALLA
Credential :
Telephone Number : 612-470-6531
Provider Enumeration Date : 12/11/2024
Last Update Date : 12/11/2024

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