MEDCENTRA LLC (NPI# 1851388920) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851388920 |
| Entity Type | Organization |
| Organization Name | MEDCENTRA LLC |
| Practice Address |
225 Smith Ave N Suite 301 Saint Paul MN 55102-2534 |
| Practice Telephone | 6512885180 |
| Practice Fax Number | 6512885188 |
| Mailing Telephone | 6512885180 |
| Mailing Fax Number | 6512885188 |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. BRIAN DAVID SISKA (PRESIDENT/) |
| Authorized Official Telephone | 7635453006 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0401X |
Clinic/Center Specialization: Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
Ambulatory Health Care Facilities |
| Street Address |
225 SMITH AVE N SUITE 301 |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55102-2534 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902805146 | Kristi R Swarthwood | Nurse Practitioner | 225 Smith Ave N, Suite 400, Saint Paul, MN 55102-2533 | 2005-07-19 |
| 1053936922 | Suzanne Moseley | Clinical Neuropsychologist | 225 Smith Ave N, Saint Paul, MN 55102-2533 | 2020-06-16 |
| 1700300720 | Jennifer Mikkelson | Nurse Practitioner | 225 Smith Ave N, Saint Paul, MN 55102-2533 | 2017-08-01 |
| 1518404268 | Jon Reynolds England | Physician Assistant | 225 Smith Ave N, Saint Paul, MN 55102-2533 | 2017-01-19 |
| 1891248977 | Lucy Bernhoft Bediako | Physician Assistant | 225 Smith Ave N, Suite 400, Saint Paul, MN 55102-2533 | 2016-07-26 |
| 1033662135 | Sonja Harlane | Registered Nurse | 225 Smith Ave N, #400, Saint Paul, MN 55102-2533 | 2016-07-26 |
| 1528413689 | Katie Reger | Psychologist | 225 Smith Ave N, Suite 201, Saint Paul, MN 55102-2533 | 2016-04-26 |
| 1053770784 | Anne Sheehan | Nurse Practitioner | 225 Smith Ave N, #400, Saint Paul, MN 55102-2533 | 2016-02-23 |
| 1306203278 | Megan Corinne Ayers Assad | Physician Assistant | 225 Smith Ave N, Suite 200, Saint Paul, MN 55102-2533 | 2016-01-24 |
| 1760868053 | Augusta Ruth Neisen | Physician Assistant | 225 Smith Ave N, Ste. 400, Saint Paul, MN 55102-2533 | 2015-08-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720623366 | Ning Wu | Acupuncturist | Tcm Health Center, 613 Grand Ave., St. Paul, MN 55102 | 2019-11-07 |
| 1730730615 | Tianwei Guo | Acupuncturist | 613 Grand Avenue, Saint Paul, MN 55102 | 2019-09-23 |
| 1194374850 | Justin Crawford Diehl | Counselor | 976 Juno Avenue, Saint Paul, MN 55102 | 2019-09-05 |
| 1699329169 | Elisabeth Johanna Wurtmann | Genetic Counselor, MS | 310 N Smith Avenue Suite 300, Saint Paul, MN 55102 | 2019-08-01 |
| 1265907083 | Lillia Budd | Nurse Practitioner | 225 Smith Ave N - Suite 400, Mail Route 65400, Saint Paul, MN 55102 | 2018-10-08 |
| 1922505098 | Women of Nations | Substance Abuse Rehabilitation Facility | 73 Leech Street, St. Paul, MN 55102 | 2018-04-06 |
| 1609371939 | Courtney Marie Klinkhammer | Student in an Organized Health Care Education/Training Program | 1026 West Seventh Street, St. Paul, MN 55102 | 2018-03-28 |
| 1427429372 | Compass Pathology and Consulting | Clinical Medical Laboratory | 360 Sherman St Suite 400b, St. Paul, MN 55102 | 2015-10-16 |
| 1639550494 | Daniel Delapp | Speech-Language Pathologist | United Hospital 333 Smith Avenue N, Mail Route 60104, St. Paul, MN 55102 | 2015-06-17 |
| 1124419940 | Suzanne Carl | Speech-Language Pathologist | 360 Colborne Avenue, St. Paul, MN 55102 | 2015-02-16 |
| Find all providers in zip 55102 | ||||
| Taxonomy Code | 261QR0401X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982922324 | Juel Fairbanks Chemical Dependency Services | Clinic/Center | 804 Albert St N, Saint Paul, MN 55104 | 2010-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912283334 | New Directions for Change | Clinic/Center | 6500 Brooklyn Blvd - Lower Level, Brooklyn Center, MN 55429 | 2011-10-31 |
| 1376514539 | Pediatric Therapy Services Inc | Clinic/Center | 150 Saint Andrews Ct, Suite 310, Mankato, MN 56001-8659 | 2006-01-27 |
| 1265784862 | Interventional Pain & Physical Medicine Clinic | Clinic/Center | 2301 Connecticut Ave S, Sartell, MN 56377-2474 | 2012-10-05 |
| 1184768277 | Rice Memorial Hospital | Clinic/Center | 301 Becker Ave Sw, Willmar, MN 56201-3302 | 2007-02-20 |
| City | SAINT PAUL |
| Zip Code | 55102 |
Please comment or provide details below to improve the information on MEDCENTRA LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.