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Contact Information

CENTRAL MEDICAL CLINIC LLC
393 N DUNLAP STREET
SUITE LL34
SAINT PAUL, MN55104
 Phone: 651-644-6002
 Fax: 651-644-2048
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pain Medicine

208VP0000X 72 Physician/Pain Management
 

Clinic/Center

261Q00000X
Indicates primary specialty

NPI Profile & details for CENTRAL MEDICAL CLINIC LLC

NPI Number 1437313434
LBN Legal business name CENTRAL MEDICAL CLINIC LLC
Authorized official MATTHEW SWANSON - (PARALEGAL)
Entity Organization
Organization subpart 1 No
Enumeration date 07/18/2008
Last updated 07/18/2008 - About 18 years ago
Identifiers
MN License # 37899
MN Medicaid 2168900
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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