Provider Demographics
NPI:1215996137
Name:ST. PAUL HEART CLINIC, P.A.
Entity type:Organization
Organization Name:ST. PAUL HEART CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MINDE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-726-2729
Mailing Address - Street 1:225 SMITH AVE N
Mailing Address - Street 2:STE 500
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2533
Mailing Address - Country:US
Mailing Address - Phone:651-292-0616
Mailing Address - Fax:651-726-7249
Practice Address - Street 1:225 SMITH AVE N
Practice Address - Street 2:STE 400
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2533
Practice Address - Country:US
Practice Address - Phone:651-292-0616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN645207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC01292Medicare ID - Type UnspecifiedCLINIC MEDICARE ID