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Organization
CENTRAL MEDICAL CLINIC LLC
Active
Organization
CENTRAL MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW J SWANSON (PARALEGAL)
(612) 922-7573
Entity
Organization
Contact information
Practice address
393 N DUNLAP STREET, SUITE LL34, ST PAUL, MN 55104
(651) 644-6002
(651) 644-2048
Mailing address
393 N DUNLAP STREET, SUITE LL34, ST PAUL, MN 55104
(651) 644-6002
(651) 644-2048
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
37899
MN
261Q00000X
Clinic/Center
37899
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2168900
—
MN
Enumeration date
07/18/2008
Last updated
07/18/2008
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