| St. Paul Family Medical Center | |
|
1239 Payne Ave Saint Paul MN 55130 | |
| (651) 209-8350 | |
| Not Available |
| Full Name | St. Paul Family Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1239 Payne Ave, Saint Paul, Minnesota |
| Authorized Official Name and Position | Phua Xiong (PRESIDENT) |
| Authorized Official Contact | 6512098350 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Paul Family Medical Center 1239 Payne Ave Saint Paul MN 55130 Ph: (651) 209-8350 | St. Paul Family Medical Center 1239 Payne Ave Saint Paul MN 55130 Ph: (651) 209-8350 |
| NPI Number | 1346302981 |
|---|---|
| Provider Enumeration Date | 12/13/2006 |
| Last Update Date | 10/17/2016 |
| Medicare PECOS PAC ID | 4789756859 |
|---|---|
| Medicare Enrollment ID | O20080707000343 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346302981 | NPI | - | NPPES |
| 01-09122 | Other | MN | MEDICA |
| 489369700 | Medicaid | MN | |
| G174 | Other | MN | PATIENT CHOICE |
| 83934 | Other | MN | HEALTHPARTNERS |
| 156J3ST | Other | MN | BLUE CROSS BLUE SHIELD |
| 170453 | Other | MN | UCARE MINNESOTA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1571 (Minnesota) | Primary |
| Provider Name | Phua Xiong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720149347 PECOS PAC ID: 4981791662 Enrollment ID: I20071026000550 |
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