Organization
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Active
Other names
Johnson High School Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
REUBEN MOORE (CEO)
(651) 602-7500
Entity
Organization
Contact information
Practice address
1349 ARCADE ST, SAINT PAUL, MN 55106-1801
(651) 778-2889
(651) 778-2890
Mailing address
153 CESAR CHAVEZ ST, SAINT PAUL, MN 55107-2226
(651) 602-7500
(651) 602-7513
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103124
UCARE
MN
05
—
523083700
—
MN
Enumeration date
01/16/2007
Last updated
05/15/2024
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