Provider Demographics
NPI:1336323328
Name:PATIENT CENTERED CARE LLC
Entity type:Organization
Organization Name:PATIENT CENTERED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RWOOF
Authorized Official - Middle Name:A
Authorized Official - Last Name:RESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-338-8424
Mailing Address - Street 1:10186 WATERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-8581
Mailing Address - Country:US
Mailing Address - Phone:651-338-8424
Mailing Address - Fax:
Practice Address - Street 1:238 WENTWORTH AVE E
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3525
Practice Address - Country:US
Practice Address - Phone:651-338-8424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44069261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1811923436OtherNPI
MNH41065Medicare UPIN