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Organization
CHILDREN'S HEALTH CARE
Active
Organization
CHILDREN'S HEALTH CARE
Active
Other names
Northeast Pediatric Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY L MASSMANN (CFO)
(612) 813-6113
Entity
Organization
Contact information
Practice address
4520 CENTERVILLE RD, VADNAIS HEIGHTS, MN 55127-3602
(651) 426-1141
Mailing address
2910 CENTRE POINTE DR, ROSEVILLE, MN 55113-1182
(651) 855-2109
(651) 855-2310
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
347125
MN
Other
Enumeration date
08/30/2010
Last updated
10/31/2022
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