Organization
MEDCENTRA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN DAVID SISKA (PRESIDENT/)
(763) 545-3006
Entity
Organization
Contact information
Practice address
225 SMITH AVE N, SUITE 301, SAINT PAUL, MN 55102-2534
(651) 288-5180
(651) 288-5188
Mailing address
225 SMITH AVE N, SUITE 301, SAINT PAUL, MN 55102-2534
(651) 288-5180
(651) 288-5188
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Enumeration date
10/04/2005
Last updated
08/22/2020
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