Provider Demographics
NPI:1952401804
Name:ST PAUL ALLERGY & ASTHMA CLINIC P.A.
Entity Type:Organization
Organization Name:ST PAUL ALLERGY & ASTHMA CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDIT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CECILE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-698-0386
Mailing Address - Street 1:565 SO SNELLNG AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1525
Mailing Address - Country:US
Mailing Address - Phone:651-698-0386
Mailing Address - Fax:651-698-0483
Practice Address - Street 1:565 S SNELLNG AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1525
Practice Address - Country:US
Practice Address - Phone:651-698-0386
Practice Address - Fax:651-698-0483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC00266Medicare PIN