Basic Information
| Provider Information | |||||||||
| NPI: | 1164154316 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHEAST MEDICAL RESEARCH INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 UNIVERSITY AVE W | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126727272 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1655 BEAM AVENUE | ||||||||
| Address2: | SUITE 102 AND SUITE 111 | ||||||||
| City: | MAPLEWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514711166 | ||||||||
| FaxNumber: | 6514712222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2022 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCCOY | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | ANDREW | ||||||||
| AuthorizedOfficialTitleorPosition: | VP AO REVENUE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 6126726594 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.