| Gillette Children's Specialty Healthcare- Grove Health | |
|
9550 Upland Lane North Suite 220 Maple Grove MN 55369 | |
| (651) 291-2848 | |
| Not Available |
| Full Name | Gillette Children's Specialty Healthcare- Grove Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 9550 Upland Lane North, Maple Grove, Minnesota |
| Authorized Official Name and Position | Patrick Nolan (CFO) |
| Authorized Official Contact | 6513123105 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gillette Children's Specialty Healthcare- Grove Health 200 University Ave E Saint Paul MN 55101-2507 Ph: (651) 291-2848 | Gillette Children's Specialty Healthcare- Grove Health 9550 Upland Lane North Suite 220 Maple Grove MN 55369 Ph: (651) 291-2848 |
| NPI Number | 1730363698 |
|---|---|
| Provider Enumeration Date | 12/27/2007 |
| Last Update Date | 12/13/2019 |
| Medicare PECOS PAC ID | 0547169211 |
|---|---|
| Medicare Enrollment ID | O20100930098169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730363698 | NPI | - | NPPES |
| 1111HGI | Other | MN | BLUE CROSS |
| 347487000 | Medicaid | MN |
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