Organization
ST PAUL PRIMARY CARE
Active
Parent organization
ST PAUL PRIMARY CARE
Other names
Park Ave Family Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST PAUL PRIMARY CARE
Authorized official
DR. KAREN LEE (MD)
(612) 817-6690
Entity
Organization
Contact information
Practice address
1345 THOMPSON AVE, SOUTH ST PAUL, MN 55075-1410
(651) 451-2711
Mailing address
2707 NICOLLET AVE, MINNEAPOLIS, MN 55408-1631
(612) 874-8811
(612) 874-0020
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
43414
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080022382
MEDICARE 080022382
MN
05
—
100025256
—
MN
Enumeration date
01/20/2015
Last updated
01/20/2015
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