Provider Demographics
NPI:1710170089
Name:SAINT FRANCIS MEDICAL CLINIC
Entity Type:Organization
Organization Name:SAINT FRANCIS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:763-753-8724
Mailing Address - Street 1:23671 SAINT FRANCIS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:MN
Mailing Address - Zip Code:55070-9802
Mailing Address - Country:US
Mailing Address - Phone:763-753-8724
Mailing Address - Fax:
Practice Address - Street 1:23671 SAINT FRANCIS BLVD NW
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070-9802
Practice Address - Country:US
Practice Address - Phone:763-753-8724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN8822261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
4728880001Medicare NSC