Organization
MINNESOTA HEAD AND NECK PAIN CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TIA A REICHERT (CHRO/CLINIC ADMINISTRATOR)
(763) 577-2484
Entity
Organization
Contact information
Practice address
2550 UNIVERSITY AVE W, STE 189S, ST PAUL, MN 55114
(651) 332-7474
(651) 332-7475
Mailing address
3475 PLYMOUTH BLVD STE 200, PLYMOUTH, MN 55447-1539
(763) 577-2484
(763) 577-1375
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11668MI
BLUE CROSS
MN
Enumeration date
07/10/2006
Last updated
07/17/2024
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