Organization
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Active
Parent organization
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Other names
Gillette Children's Professional Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Authorized official
PATRICK NOLAN (CFO)
(651) 312-3105
Entity
Organization
Contact information
Practice address
200 EAST UNIVERSITY AVE, ST. PAUL, MN 55101
(651) 291-2848
(651) 325-2250
Mailing address
200 EAST UNIVERSITY AVE, ST. PAUL, MN 55101
(651) 291-2848
(651) 325-2250
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0578435
—
IA
05
—
1225119175
—
MN
01
—
29006TE
BLUE CROSS & BLUE SHIELD
MN
05
—
32809900
—
WI
Enumeration date
10/18/2006
Last updated
12/13/2019
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