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Organization
PEDIATRIC AND YOUNG ADULT MEDICINE, PA
Active
Organization
PEDIATRIC AND YOUNG ADULT MEDICINE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERRI M JOSEPH (OFFICE MANAGER)
(651) 256-6706
Entity
Organization
Contact information
Practice address
3470 WASHINGTON DR, SUITE 201, EAGAN, MN 55122-1355
(651) 256-6706
(651) 256-6766
Mailing address
1804 7TH ST W, SUITE 200, SAINT PAUL, MN 55116-2300
(651) 256-6706
(651) 256-6766
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
154
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083694046
—
MN
05
—
1104806165
—
MN
05
—
1245210095
—
MN
05
—
1245210210
—
MN
05
—
1386991339
—
MN
05
—
1477870921
—
MN
05
—
1497735419
—
MN
05
—
1861558835
—
MN
05
—
1881057065
—
MN
05
—
1912987900
—
MN
Enumeration date
04/03/2009
Last updated
12/07/2016
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