Healtheast Grand Avenue Clinic
LBN: Healtheast Medical Research Institute
Healtheast Grand Avenue Clinic is an health care organization with primary practice located at 870 Grand Ave , Saint Paul MN 55105-3291. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Clinic/Center, Suppliers / Durable Medical Equipment & Medical Supplies. Ambulatory Health Care Facilities / Clinic/Center is the primary health care specialty.
Healtheast Medical Research Institute can be contacted via phone (651) 326-5650, or through Davenport, Doug via phone (651) 232-2250.
Contact Information
Primary practice address
870 Grand Ave
Saint Paul MN 55105-3291
Phone: (651) 326-5650
Fax: (651) 326-5671
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Clinic/Center | 261Q00000X | ||
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X |
Profile Details
| NPI number | 1730128398 |
|---|---|
| LBN Legal business name | Healtheast Medical Research Institute |
| DBA Doing business as | Healtheast Grand Avenue Clinic |
| Authorized official | Davenport, Doug |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | Jun 6th, 2006 |
| Last updated | May 21st, 2015 - about 9 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1730128398 | NPPES |
| Minnesota | Other | 0841630019 | MEDICARE PTAN |
| Minnesota | MEDICAID | 500719400 | MEDICARE PTAN |
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