Provider Demographics
NPI:1114247061
Name:THE DOCTORS MEDICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:THE DOCTORS MEDICAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-771-2513
Mailing Address - Street 1:1504 WHITE BEAR AVE N
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:217 COMO AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1838
Practice Address - Country:US
Practice Address - Phone:651-771-2513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty