Provider Demographics
NPI:1598817678
Name:CITY OF MINNEAPOLIS
Entity Type:Organization
Organization Name:CITY OF MINNEAPOLIS
Other - Org Name:MINNEAPOLIS DEPARTMENT OF HEALTH AND FAMILY SUPPORT SCHOOL BASED CLINI
Other - Org Type:Other Name
Authorized Official - Title/Position:SBC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KYLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-673-5305
Mailing Address - Street 1:505 4TH AVE S RM 520
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1345
Mailing Address - Country:US
Mailing Address - Phone:612-673-2301
Mailing Address - Fax:612-673-3866
Practice Address - Street 1:3131 19TH AVENUE SOUTH
Practice Address - Street 2:ROOM 122
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409
Practice Address - Country:US
Practice Address - Phone:612-668-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local